World Journal of Urology

, Volume 25, Issue 2, pp 207–213 | Cite as

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat

  • Shinji Urakami
  • Hiroaki Shiina
  • Hideki Enokida
  • Ken Kawamoto
  • Nobuyuki Kikuno
  • Thomas Fandel
  • Kaveh Vejdani
  • Lora Nunes
  • Mikio Igawa
  • Emil A. Tanagho
  • Rajvir Dahiya
Original Article

Abstract

Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.

Keywords

Bladder acellular matrix graft Bladder augmentation Spinal cord injury Neurogenic bladder Tissue engineering 

Notes

Acknowledgments

Support: Department of Defense (DOD), VA Merit Review and Deutsche, Forschungsgemeinschaft FA 479/1-1.

References

  1. 1.
    Kruse MN, Belton AL, de Groat WC (1993) Changes in bladder and external urethral sphincter function after spinal cord injury in the rat. Am J Physiol 264:R1157–1163PubMedGoogle Scholar
  2. 2.
    Shaker H, Mourad MS, Elbialy MH, Elhilali M (2003) Urinary bladder hyperreflexia: a rat animal model. Neurourol Urodyn 22:693–698PubMedCrossRefGoogle Scholar
  3. 3.
    Kashif KM, Holmes SA (1998) The use of small intestine in bladder reconstruction. Int Urogynecol J Pelvic Floor Dysfunct 9:275–280PubMedCrossRefGoogle Scholar
  4. 4.
    Shekarriz B, Upadhyay J, Demirbilek S, Barthold JS, Gonzalez R (2000) Surgical complications of bladder augmentation: comparison between various enterocystoplasties in 133 patients. Urology 55:123–128PubMedCrossRefGoogle Scholar
  5. 5.
    Piechota HJ, Dahms SE, Nunes LS, Dahiya R, Lue TF, Tanagho EA (1998) In vitro functional properties of the rat bladder regenerated by the bladder acellular matrix graft. J Urol 159:1717–1724PubMedCrossRefGoogle Scholar
  6. 6.
    Piechota HJ, Dahms SE, Probst M, Gleason CA, Nunes LS, Dahiya R, Lue TF, Tanagho EA (1998) Functional rat bladder regeneration through xenotransplantation of the bladder acellular matrix graft. Br J Urol 81:548–559PubMedGoogle Scholar
  7. 7.
    Piechota HJ, Gleason CA, Dahms SE, Dahiya R, Nunes LS, Lue TF, Tanagho EA (1999) Bladder acellular matrix graft: in vivo functional properties of the regenerated rat bladder. Urol Res 27:206–213PubMedCrossRefGoogle Scholar
  8. 8.
    Wefer J, Sievert KD, Schlote N, Wefer AE, Nunes L, Dahiya R, Gleason CA, Tanagho EA (2001) Time dependent smooth muscle regeneration and maturation in a bladder acellular matrix graft: histological studies and in vivo functional evaluation. J Urol 165:1755–1759PubMedCrossRefGoogle Scholar
  9. 9.
    Dahms SE, Piechota HJ, Dahiya R, Gleason CA, Hohenfellner M, Tanagho EA (1998) Bladder acellular matrix graft in rats: its neurophysiologic properties and mRNA expression of growth factors TGF-alpha and TGF-beta. Neurourol Urodyn 17:37–54PubMedCrossRefGoogle Scholar
  10. 10.
    Youssif M, Shiina H, Urakami S, Gleason C, Nunes L, Igawa M, Enokida H, Tanagho EA, Dahiya R (2005) Effect of vascular endothelial growth factor on regeneration of bladder acellular matrix graft: histologic and functional evaluation. Urology 66:201–207PubMedCrossRefGoogle Scholar
  11. 11.
    Blaivas JG (1982) The neurophysiology of micturition: a clinical study of 550 patients. J Urol 127:958–963PubMedGoogle Scholar
  12. 12.
    Pesce F, Castellano V, Finazzi Agro E, Giannantoni A, Tamburro F, Vespasiani G (1997) Voiding dysfunction in patients with spinal cord lesions at the thoracolumbar vertebral junction. Spinal Cord 35:37–39PubMedCrossRefGoogle Scholar
  13. 13.
    Light JK, Faganel J, Beric A (1985) Detrusor areflexia in suprasacral spinal cord injuries. J Urol 134:295–297PubMedGoogle Scholar
  14. 14.
    Cayan S, Chermansky C, Schlote N, Sekido N, Nunes L, Dahiya R, Tanagho EA (2002) The bladder acellular matrix graft in a rat chemical cystitis model: functional and histologic evaluation. J Urol 168:798–804PubMedCrossRefGoogle Scholar
  15. 15.
    de Groat WC, Kawatani M, Hisamitsu T, Cheng CL, Ma CP, Thor K, Steers W, Roppolo JR (1990) Mechanisms underlying the recovery of urinary bladder function following spinal cord injury. J Auton Nerv Syst 30 Suppl:S71–77PubMedGoogle Scholar
  16. 16.
    Barton CH, Khonsari F, Vaziri ND, Byrne C, Gordon S, Friis R (1986) The effect of modified transurethral sphincterotomy on autonomic dysreflexia. J Urol 135:83–85PubMedGoogle Scholar
  17. 17.
    de Seze M, Wiart L, de Seze MP, Soyeur L, Dosque JP, Blajezewski S, Moore N, Brochet B, Mazaux JM, Barat M, Joseph PA (2004) Intravesical capsaicin versus resiniferatoxin for the treatment of detrusor hyperreflexia in spinal cord injured patients: a double-blind, randomized, controlled study. J Urol 171:251–255PubMedCrossRefGoogle Scholar
  18. 18.
    Khullar V, Chapple C, Gabriel Z, Dooley JA (2006) The effects of antimuscarinics on health-related quality of life in overactive bladder: a systematic review and meta-analysis. Urology 68:38–48PubMedCrossRefGoogle Scholar
  19. 19.
    Finney SM, Andersson KE, Gillespie JI, Stewart LH (2006) Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions? BJU Int 98:503–507PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Shinji Urakami
    • 1
    • 2
  • Hiroaki Shiina
    • 1
    • 2
  • Hideki Enokida
    • 1
    • 3
  • Ken Kawamoto
    • 1
    • 3
  • Nobuyuki Kikuno
    • 1
    • 2
  • Thomas Fandel
    • 1
  • Kaveh Vejdani
    • 1
  • Lora Nunes
    • 1
  • Mikio Igawa
    • 2
  • Emil A. Tanagho
    • 1
  • Rajvir Dahiya
    • 1
  1. 1.Department of Urology, Veterans Affairs Medical CenterUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Urology, Faculty of MedicineShimane UniversityIzumoJapan
  3. 3.Department of Urology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan

Personalised recommendations