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Bladder augmentation using acellular collagen biomatrix: a pilot experience in exstrophic patients

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Abstract

Purpose

A preliminary experience on in vivo bladder wall regeneration in a subset of patients born with exstrophy–epispadias complex is reported. The objective was to improve bladder capacity and compliance without bowel augmentation.

Methods

Five patients (3 males, 2 females), mean age 10.4 years, presenting poor bladder capacity and compliance after complete exstrophy repair, underwent bladder augmentation using small intestinal submucosa (SIS) scaffold. Ultrasonography, cystoscopy with cystogram, assessment of bladder volume and compliance and bladder biopsy were performed before surgery (T0), at 6 (T1) and 18 months (T2) follow-up. Histology was compared with normal bladder specimens. Wilcoxon test was adopted for statistics.

Results

Bladder capacity and compliance resulted increased (+30%) at T1 (p < 0.05) and remained stable at T2, despite dry intervals did not changed significantly. Bladder biopsy at T1 showed no evidence of SIS, but normal transitional mucosa and sero-muscular layer containing smooth muscle fascicles, small nerve trunks and vessels within abundant type-3 collagen. Muscle/collagen ratio was decreased compared with controls at T1 and T2 (p < 0.05). No kidney damage, bladder diverticula, or stones were observed at 3 years follow-up.

Conclusions

Bladder regeneration was feasible in these patients, but bladder capacity and compliance was poorly increased to obtain significant clinical benefit. Histology showed poor muscle components. The acellular matrix grafting failed to provide long-term effective results in terms of continence achievement.

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Acknowledgments

The study was supported by a grant (code #: 200702R002233) of the National Health Ministry.

Conflict of interest

No conflict of interest exists in relation to this article.

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Authors and Affiliations

  1. Division of Pediatric Urology, Department of Nephrology-Urology, “Bambino Gesù” Children’s Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy

    Paolo Caione, Annamaria Salerno & Simona Gerocarni Nappo

  2. Division of Pathology, Department of Laboratories, “Bambino Gesù” Children’s Hospital, IRCCS, Rome, Italy

    Renata Boldrini

Authors
  1. Paolo Caione
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  2. Renata Boldrini
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  3. Annamaria Salerno
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  4. Simona Gerocarni Nappo
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Correspondence to Paolo Caione.

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Caione, P., Boldrini, R., Salerno, A. et al. Bladder augmentation using acellular collagen biomatrix: a pilot experience in exstrophic patients. Pediatr Surg Int 28, 421–428 (2012). https://doi.org/10.1007/s00383-012-3063-0

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  • DOI: https://doi.org/10.1007/s00383-012-3063-0

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