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Enzymatic treatment of ileal segments used for urinary tract reconstruction

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Abstract

Urinary tract reconstruction by using various gastrointestinal segments is not devoid of complications which may hamper to a great extent the beneficial effects of the procedure. Intestinal mucosa is the primary site responsible for these complications and any procedure aiming at the prevention of untoward effects of intestinal interposition should abolish the absorptive and secretory functions of the mucosa. Augmentation cystoplasties by ileal segments were performed on 24 male albino Wistar rats. In 12 animals de-epithelialization of the mucosa with an enzymatic cock-plasty. The functional capacity of the epithelium was determined by a simplified glucose absorption test in the third postoperative week. Morphological examiniation before the absorption test did not reveal any fibrosis or shrinkage of the ileal segments. Complete elimination of the absorptive capability in enzyme treated mucosa was found during the glucose absorption test, while a rapid and highly effective absorption was observed in the control group (p<0.05).

As a result, it seems possible to obtain intestinal segments covered with a mucosa which acquired similar characteristics to uro-epithelium, therefore closely resembling the original urinary tissues.

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References

  1. Motley, R. C., Montgomery, B. T., Zollman, P. E., Holley, K. E., Kramer, S. A.: Augmentation cystoplasty utilizing de-epithelialized sigmoid colon: A preliminary study.J. Urol., 143, 1257 (1990).

    PubMed  CAS  Google Scholar 

  2. Salle, J. L. P., Fraga, C. S., Lucib, A., Lampertz, M., Jobim, G., Jobim, G., Putten, A.: Seromuscular cystoplasty in dogs.J. Urol., 144, 454 (1990).

    PubMed  CAS  Google Scholar 

  3. Rowland, R. G., Mitchell, M. E.: Perspectives on cystectomy and diversion. In: AUA Update Series, volume IV, lesson 29, 1985.

  4. Klimberg, I. W., Wajsman, Z.: Treatment for muscle invasive carcinoma of the bladder.J. Urol., 136, 1169 (1986).

    PubMed  CAS  Google Scholar 

  5. Golomb, J., Klutke, C. G., Lewin, K. J., Goodwin, W. E., deKernion, J. B., Raz, S.: Bladder neoplasms associated with augmentation cystoplasty. Report of 2 cases and literature review.J. Urol., 142, 377 (1989).

    PubMed  CAS  Google Scholar 

  6. Hendren, H. W., Hendren, R. B.: Bladder augmentation: Experience with 129 children and young adults.J. Urol., 144, 445 (1990).

    PubMed  CAS  Google Scholar 

  7. Mitchell, M. E., Piser, J. A.: Intestinocystoplasty and total bladder replacement in children and young adults. Follow-up in 129 cases.J. Urol., 138, 579 (1987).

    PubMed  CAS  Google Scholar 

  8. Lieskovsky, G., Skinner, D. G.: Use of intestinal segments in the urinary tract. In: Walsh, P. C., Gittes, R. F., Perlmutter, A. D., Stamey, T. A. (eds.). Campbell's Urology, 5th edition W. B. Saunders Comp., Philadelphia 1986, pp. 2620–2638.

    Google Scholar 

  9. Thüroff, J. W., Alken, P., Riedmiller, H., Engelmann, U., Jacobi, G. H., Hohenfellner, R.: The Mainz pouch (mixed augmentation ileum and cecum) for bladder augmentation and continent diversion.J. Urol., 136, 17 (1986).

    PubMed  Google Scholar 

  10. Melchior, H., Spehr, C., Knop-Wagemann, I.: The continent ileal neobladder for urinary tract reconstruction after cystectomy: A survey of 44 patients.J. Urol., 139, 714 (1988).

    PubMed  CAS  Google Scholar 

  11. Elder, J. S., Snyder, H. M., Hulbert, W. C., Duckett, J. W.: Perforation of the augmented bladder in patients undergoing clean intermittent catheterization.J. Urol., 140, 1159 (1988).

    PubMed  CAS  Google Scholar 

  12. Rushton, H. G., Woodard, J. R., Parrott, T. S., Jeffs, R. D., Gearhart, J. P.: Delayed bladder rupture after augmentation cystoplasty.J. Urol., 140, 344 (1988).

    PubMed  CAS  Google Scholar 

  13. Sheiner, J. R., Kaplan, G. W.: Spontaneous bladder rupture following enterocystoplasty.J. Urol., 140, 1157 (1988).

    PubMed  CAS  Google Scholar 

  14. Haupt, G., Pannek, J., Knopf, H. J., Schulze, H., Seng, T. H.: Rupture of ileal neobladder due to urethral obstruction by mucous plug.J. Urol., 144, 740 (1990).

    PubMed  CAS  Google Scholar 

  15. Graversen, P. H., Gasser, T. C., Friedman, A. L., Bruskewitz, R. C.: Surveillance of long term metabolic changes after urinary diversion.J. Urol., 140, 818 (1988).

    PubMed  CAS  Google Scholar 

  16. Raz, S., Ehrlich, R. M., Zeidman, E. J., Alarcon, A., McLaughlin, S.: Surgical treatment of the incontinent female patient with meningomyelocele.J. Urol., 139, 524 (1988).

    PubMed  CAS  Google Scholar 

  17. Savariragen, F., Dixey, G. M.: Syncope following ureterosigmoidostomy.J. Urol., 101, 844 (1969).

    Google Scholar 

  18. Zabbo, A., Kay, R.: Ureterosigmoidostomy and bladder exstrophy: A long term follow-up.J. Urol., 136, 396 (1986).

    PubMed  CAS  Google Scholar 

  19. Marcheggiano, A., Iannoni, C., Latella, G., Frieri, G., Diosi, D., DeDominics, C., Laurenti, C., Caprilli, R.: Abnormalities of colonic mucin secretion and metabolic changes after internal urinary diversion for bladder exstrophy. A prospective study.Br. J. Urol., 67, 477 (1991).

    PubMed  CAS  Google Scholar 

  20. Crissey, M. M., Steele, G. D., Gittes, R. F.: Rat model for carcinogenesis in ureterosigmoidostomy.Science, 207, 1079 (1980).

    Article  PubMed  CAS  Google Scholar 

  21. Stewart, M., Macrae, F. A., Williams, C. B.: Neoplasia and ureterosigmoidostomy: A colonoscopy survey.Br. J. Urol., 69, 414 (1982).

    CAS  Google Scholar 

  22. Shoemaker, W. C.: Reversed seromuscular grafts in urinary tract reconstruction.J. Urol., 74, 453 (1955).

    PubMed  CAS  Google Scholar 

  23. Canning, D. A., Perman, J. A., Jeffs, R. D., Gerhart, J. P.: Nutritional consequences of bowel segments in the lower urinary tract.J. Urol., 142, 509 (1989).

    PubMed  CAS  Google Scholar 

  24. Goldwasser, B., Barret, D. M., Benson, R. C.: Bladder replacement with use of a detubularized right colonic segment: Preliminary report of a new technique.Mayo Clin. Proc., 61, 615 (1986).

    PubMed  CAS  Google Scholar 

  25. McDougal, W. S.: The continent urinary diversion.J. Urol., 137, 1214 (1987).

    PubMed  CAS  Google Scholar 

  26. Golimbu, M., Morals, P.: Electrolyte, disturbances in jejunal urinary diversion.Urology, 1, 432 (1973).

    Article  PubMed  CAS  Google Scholar 

  27. McDougal, W. S.: Bladder reconstruction following cystectomy by uretero-ileocutaneostomy.J. Urol., 135, 698 (1986).

    PubMed  CAS  Google Scholar 

  28. Narayan, P., Broderick, G. A., Tanagho, E. A.: Bladder substitution with ileocecal (Mainz) pouch. Clinical performance over 2 years.Br. J. Urol., 68, 588 (1991).

    Article  Google Scholar 

  29. Kennedy, H. A., Adams, M. C., Mitchell, M. E., Rink, R. C., Piser, J. A., McNulty, A.: Chronic renal failure and bladder augmentation: Stomach versus sigmoid colon in the canine model.J. Urol., 140, 1138 (1988).

    PubMed  CAS  Google Scholar 

  30. Plawker, M. W., Rabinowitz, S. S., Etwaru, D. J., Glassberg, K. I.: Hypergastrinemia, dysuria-hematuria and metabolic alkalosis: Complications associated with gastrocystoplasty.J. Urol., 154, 546 (1995).

    Article  PubMed  CAS  Google Scholar 

  31. Adams, M. C., Mitchell, M. E., Rink, R.: Gastrocystoplasty: An alternative solution to the problem of urological reconstruction in the severely compromised patient.J. Urol., 140, 1152 (1988).

    PubMed  CAS  Google Scholar 

  32. Campbell, E. W.: Reconstruction of the bladder with a seromuscular graft.J. Urol., 78, 236 (1957).

    PubMed  CAS  Google Scholar 

  33. Bowman, W. C., Rand, M. J.: Subcellular organization and cellular metabolism. In: Bowman, W. C., Rand, M. J. (eds.). Textbook of Pharmacology. Second edition. Blackwell Scientific Publications, Oxford, Chapter 2, 1980, pp. 1–44.

    Google Scholar 

  34. Guyton, A. C.: Digestion and absorption in the gastrointestinal tract. In: Guyton, A. C. (ed.). Medical Physiology. W. B. Saunders Company, sixth ed., Philadelphia 1981, pp. 816–826.

    Google Scholar 

  35. Turnberg, L. A., Bieberdorf, F. A., Morawski, S. G., Fordtran, J. S.: Interrelationships of chloride, bicarbonate, sodium and hydrogen ion transport in the human ileum.J. Clin. Invest., 49, 557 (1970).

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey

    L. N. Türkeri, F. Simsek, Y. N. Ilker & A. Akdaş

  2. Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey

    A. Sav

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  1. L. N. Türkeri
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  2. F. Simsek
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  3. A. Sav
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  4. Y. N. Ilker
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  5. A. Akdaş
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Türkeri, L.N., Simsek, F., Sav, A. et al. Enzymatic treatment of ileal segments used for urinary tract reconstruction. International Urology and Nephrology 28, 655–663 (1996). https://doi.org/10.1007/BF02552161

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