Experimental Study on Ileocystoplasty: 3. Function of Bladder after ileocystoplasty

Kim, Kee Soo; Lee, H S

Abstract

The purpose of ileocystoplasty is to augment bladder capacity and the reconstructed bladder must not only be able to empty but also be able to contain urine in a physiologic manner. Low intravesical pressure with minimum reabsorption of electrolytes is desirable. In previous studies I have described a new reliable technique of ileocystoplasty with a satisfactory clinical application. The purpose of this study was to evaluate the physiologic aspects concerning several different types of ileocystoplasty.
METHODS AND RESULTS
Healthy 8 Korean dogs were utilized. The animals weighed from 15 to 20kg. The two layer open flap method of ileocystoplasty was performed in four dogs and the other four dogs received ring plastic type. Intravesical pressure was measured by a water manometer and all measurements were read directly from the manometer tube. In order to obtain standard controls cystometrograms were done in 3 normal dogs. The normal dog bladder was found to respond to increased intravesical fluid and the average bladder capacity was 130cc. The voiding pressure was 28cm in water. The average fluid capacity of the reconstructed bladder was 120cc in two layer open flap method and 150c. c. in ring plastic method. The cystometry 10 minutes after intermuscular injection of 1.0cc. of 1:2000 prostigmin solution disclosed a definite increase in vesical fluid pressure in ring plastic type whereas the two layer open flap type did not show any elevation. Administration of 0.4mg of atropine intramuscularly decreased intravesical pressure in ring plastic type but was not significant in two layer open flap type. Injection of 10cc. of 0.25% pentothal sodium intravenously caused decrease of fluid pressure in both types. Emptying activity of the reconstructed bladder was measured by x-ray retrograde cystogram methods. The opaque medium remained in the ileal loop for 24 hours after onset of voiding in ring plastic type but no opaque medium was seen in the two layer open flap type. Absorption of electrolytes from the bladder after the two layer open flap ileocystoplasty was not altered significantly. The postoperative electrolyte plasma values of potassium and sodium chlorides were within normal limits. Histologic examinations of the ileal bladder 2 months after the open flap ileocystoplasty disclosed varying degrees of non-specific inflammatory reactions. No metaplasia or loss of mucous glands was seen.