Experimental Study on Ileocystoplasty: 2. Production of Collateral Blood Supply to the Ileac Segment After Ileocystoplasty

Kim, Kee Soo; Lee, H S

Abstract

The use of isolated segment of ileum as urinary conduits has found wide acceptance in recent years in urological field. The procedures by various investigators have been proven valuable by fairly extensive clinical trial. However, to achieve a satisfactory ileocystoplasty by a viable flap serious consideration should be given to the lymphatic and vascular factors involved in this procedure. It was therefore decided to observe carefully a production of collateral blood supply to the ileal segment after ileocystoplasty.
MATERIALS AND METHODS
Healthy 9 Korean dogs: weighing from 15 to 30 kg were used. One animal was used for a preliminary study. The two layer open flap ileocystoplasty previously described was performed in four dogs and the other four dogs received ringplastic type operation. All of the animals were divided into our different groups to receive different manipulation. In the first group of two dogs. the blood supply to the ileal segment from its mesentery was clamped, cut and ligated immediately after each procedure. In the second group of two dogs cessation of blood supply was performed as above 2 weeks after ileocystoplasty. In the third group of two dogs, the same have been done 4 weeks after the initial operation. The last group of two dogs 8 weeks elapsed before interruption of blood supply was carried out. Animals were sacrificed two weeks after interruption of blood supply from mesentery and gross and microscopic studies were made.
RESULTS
AND SUMMARY: 1. When the blood supply to the ileal bladder from its mesentery was interrupted immediately after ileocystoplasty, animals expired in 3 to 6 days suffering from gangrene of the ileal segment. Purulent exudate was present between the ileal segment and urinary bladder. 2. When the blood supply to the ileal bladder was interrupted 2 weeks after ileocystoplasty. animals survived and were found to have undergone spontaneous omentopexy but anastomosed ileal segment appeared not viable because of atrophy. 3. When cessation of blood supply was done 8 weeks after ileocystoplasty, animals made an uneventful postoperative recovery and the ileal segment and urinary bladder appeared normal with good collateral circulation from omentum and original bladder 4.There was no significant difference among the types of ileocystoplasty in the formation of collateral blood supply.