CLINICAL STUDIES ON CYSTOPLASTY

A Study on Cystoplasty by Regeneration in Some Cases of Tumor of Bladder Using Novectane (Liquid Synthetic Resin)—Sprayed Thin Paper (2)

Abstract

In 1971 we reported papers entitled, ‘Some Clinical Evaluation on Cystoplasty Utilizing “Nobectane” Sprayed Gelatin Sponge.’ Subsequently through the original research work of Taguchi, we further reported ‘A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-Sprayed Thin Paper (1), (2), and (3).’ These papers dealt with the classification of various cases of tuberculous contracted bladder into three types and with the regeneration of the contracted bladder using a synthetic resin which has thin Japanese paper as a padding, for a prescribed period of time, thus enabling enlargement of the bladder and spontaneous urination. Furthermore, the application of this regeneration showed a new system of treatment by cystoplasty.
Taguchi also applied such experience to the treatment of tumor of bladder. The purpose of this cystoplasty is to let the bladder regenerate and to make spontaneous urination possible by the same method as in the contracted bladder.
The operative procedure for tumor of bladder consists of, in principle, the two types as given in Fig. 1 and 2.
The type I (Fig. 1) is the procedure in which the bladder is excised, leaving the trigone and the neck inclusive of both uretheral meatuses or leaving a part of them. Consequently, any procedure that leaves a part of the bladder, however small, belongs to type I. The artificial material used is a conical membrane of synthetic resin having a thin Japanese paper padding. This has been employed since 1970 as already reported. In 3 to 4 weeks after the operation the artificial material is removed transurethrally.
Case 1 is a 40 year-old male. This is the case reported in “A Study on Cystoplasty by Regeneration in a Case of Tumor of Bladder Using Novectane (Liquid Synthetic Resin)—Sprayed Thin Paper (1) ”. He was suffering from the 3rd degree transitional epithelial tumor and was operated on by the procedure, type I. Four years have passed since then, and at present the capacity of his bladder is 300 to 400cc with normal urine and renal function.
Case 2 is a 60 year-old male who was subjected to the type I operation. He was suffering from the 3rd degree transitional epithelial tumor. The capacity of his bladder reached 300cc in 3 months after the operation. The cystogram taken one year later indicated a normal state as shown in Fig. 4. In 2 years his single urination reached 300 to 400cc and the urine analysis indicated a normal state.
The type II (Fig. 2) is a whole excision of the bladder except a part of the posterior urethra. The inner glands of the prostate are also excised in the case of male.
Case 3 is a 58 year-old male who was subjected to the type II operation The cystogram indicated filling defects all over the bladder as shown in Fig. 5. Fig. 6 shows a state when the whole bladder and prostate inner glands together with a part of peritoneum were excised. The excised bladder indicated the spread of tumor almost all over the bladder wall except the bladder neck, proving to be 2nd to 3rd degree transitional epithelial cancer. Spontaneous urination at one time was 100 to 120cc, 4 months after cystoplasty. In Fig. 8 is shown a cystogram taken 2 years 6 months after cystoplasty. The remakable vesicoureteral reflux was noticed similarly to the observation made 5 months after cystoplasty. When compared with excretory pyelogram taken prior to the operation, conspicuous enlargement of the pelvis of the kidney and of the ureter were observed. Little difference, however, was found in the renal functions before the operation, 5 months and 2 years 6 months after operation. Fig. 9A is a cystogram taken one year after cystoplasty and Fig. 9B is the one taken 3 years later, revealing distinct formation of granular tissue.
Case 4 is a 46 year-old male who was subjected to the type II operatio