CLINICAL STUDIES ON CYSTOPLASTY

A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (3)

Abstract

Case 1 reported in “A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (I)” showed the simplest symptoms of tuberculous contracted bladder.
Cystoplasty was conducted for a certain period on this case by means of an artificial material prepared by spraying Novectane on a core of thin Japanese paper, with a successful result of increasing the bladder capacity from 50-60 to 400cc. This case has been under postoperative clinical observation for more than four years.
Case 2, one of the two cases reported in the same “series (2)”, had a bladder capacity of 20cc with vesico-ureteral refiux. Another case, Case 3, who had been urinating through nephrostomy for more than a year because of complete stricture at the lower end of ureter, had a bladder capacity of approximately 50cc. Both cases underwent cystoplasty and ureterovesicostomy simultaneously, which succeeded in increasing the single urination volume up to 300-400cc. These cases have been under postoperative clinical observation for more than three years.
Case 4 in the present report is a 34 years old male. To his left residual kidney is inserted a Nelaton's catheter through which he urinated for more than three years. The presence of calculus was confirmed in the upper ureter. Fig. 1 is a radiophotogram of the calculus as indicated by an arrow. The bladder and urethra show conspicuous pathological states with the bladder capacity of less than 3 cc and extensive tuberculous stricture in the urethra. Fig. 2 shows a state of contracted bladder and urethrostenosis. A Nelaton's catheter is inserted into the lowest part of the pelvis renalis and the calculus and the extensive complete stricture are present at the upper and lower parts of the ureter, respectively. Fig. 3-(1) gives patterns of the pelvis renalis, ureter, and bladder. The state of Case 4 may be expressed by (1) left renal fistula, (2) ureteral calculus, (3) extensitive complete ureteral stricture, (4) contracted bladder with a capacity below 3 cc and (5) urethra stricture. This is the most serious state in urinary tuberculosis as shown in Fig. 4-(A).
The treatment was commenced with urethral divulsion using a filiform bougie or a metal bougie. The enlargement was attained to 30 Foff the metal bougie. Ureterolithotomy was conducted, followed by the primary cystoplasty. The contracted bladder, that was almost a walnut in size, was subjected to crucial incision to remove hard cicatricial wall of the bladder. A3×2.5cm membrane wall of the bladder obtained was sutured with an artificial bladder using 00 cutgut. The fallen artificial material was removed transurethrally one month later. Figs. 5 and 6 show the state at the primary cystoplasty. The muscle as shown in Fig. 7 was obtained from the bladder wall at that time.
Since one month after the primary cystoplasty, 0.1% Urocydal solution was introduced into the regenerated bladder until the patient had a desire to urinate, to make him forbear urinating for 30 to 60 minutes. This treatment was repeated till the previous day of the second cystoplasty. As shown in Fig. 3-(2) and Fig. 4-(B), the contracted bladder of about 3 cc was enlarged to a regenerated one of 90 cc.
The secondary cystoplasty consisted of anastomosing the ureter and the ileum, and subsequently ileum and the regenerated bladder to reconstruct the whole urinary pathway. The bladder regenerated to 90 cc was fist-sized, protruding into the pelvic cavity. The bladder wall was found 0.5 to 0.8cm in thickness when subjected to crucial incision. Figs. 8 and 9 show the regenerated bladder. As Shown in Fig. 10, occurrence of the muscle was proved in the regenerated bladder wall. The regenerated bladder subjected to crucial incision was anastomosed to the ileum which had been anastomosed to the ureter. Fig. 11 shows the state after completion of the anastomosis. Fig. 4-(C) show