Experimental Bladder Reconstruction

Hans Frederiksen

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

136 Nedladdningar (Pure)

Sammanfattning

Reduced urinary bladder capacity is a clinically significant problem. The surgical methods that have been available to treat this, such as urinary diversion or surgically augmenting the bladder by incorporation of intestinal segments, all have serious drawbacks. There is a need to understand how the smooth muscle of the intestine and bladder can interact when brought into close contact surgically, and also to develop methods to reconstruct the bladder without using intestinal segments.

The experiments on bladder reconstruction performed in this study ? regeneration after subtotal cystectomy, replacement with bowel segments and matrix grafts ? show that the bladder has a high capacity for regenerative growth. After enterocytstoplasty, nerves from the bladder grow into the intestinal segment, in which ganglionic atrophy appears.This is a possible explanation to the shift in pharmacological properties shown to occur in such segments with time, a phenomenon also found in our experiments. The cystometric findings in animals operated with enterocystoplasty suggest that the bowel segment, at least to some degree, participates in the emptying of the bladder, i.e. the intestinal muscle is functionally integrated into the bladder wall and not merely a passive part during emptying. The findings after subtotal cystectomy show that the rat bladder can produce new, contracting muscle, although with lowered maximal shortening velocity and lowered maximal force production ability compared to controls. The nerves found in the bladder developing after subtotal cystectomy represent growth and branching of pre-existing nerves. The nerves found in the small intestinal submucosa matrix grafts are a continuation of nerve trunks from the bladder reaching the grafts at the suture line. The nerve trunks and muscle bundles in the subtotally cystectomized bladders and in the matrix grafts do not fully attain the growth pattern found in normal bladders.
Originalspråkengelska
KvalifikationDoktor
Tilldelande institution
  • Urologi
Handledare
  • Uvelius, Bengt, handledare
Tilldelningsdatum2007 sep. 28
Förlag
ISBN (tryckt)978-91-85897-03-2
StatusPublished - 2007

Bibliografisk information

Defence details

Date: 2007-09-28
Time: 09:00
Place: Föreläsningssal 3, Blocket, Universitetssjukhuset i Lund

External reviewer(s)

Name: Levin, Robert M.
Title: Prof.
Affiliation: Albany College of Pharmacy, Albany, New York, USA

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<div class="article_info">H Frederiksen, T Davidsson, W Månsson and B Uvelius. <span class="article_issue_date">1999</span>. <span class="article_title">Sprouting of bladder nerves into cystoplastic cecal segment in the rat.</span> <span class="journal_series_title">Urol. Res.</span>, <span class="journal_volume">vol 27</span> <span class="journal_pages">pp 476-482</span>.</div>
<div class="article_info">H Frederiksen, R Sjuve, A Arner and B Uvelius. <span class="article_issue_date">2001</span>. <span class="article_title">Regeneration of detrusor muscle after subtotal cystectomy in the rat; effects on contractile proteins and bladder mechanics.</span> <span class="journal_series_title">Neurourol & Urodyn</span>, <span class="journal_volume">vol 20</span> <span class="journal_pages">pp 685-697</span>.</div>
<div class="article_info">H Frederiksen, A Arner, U Malmqvist, R Sjuve and B Uvelius. <span class="article_issue_date">2004</span>. <span class="article_title">Nerve induced responses and force-velocity relations of regenerated detrusor muscle after subtotal cystectomy in the rat.</span> <span class="journal_series_title">Neurourology and Urodynamics</span>, <span class="journal_volume">vol 23</span> <span class="journal_pages">pp 159-165</span>.</div>
<div class="article_info">Y Semerdzhiev, H Frederiksen, P Hedlund, T Davidsson, W Månsson and B Uvelius. <span class="article_issue_date">2006</span>. <span class="article_title">Cystometric and in-vitro muscle studies of cystoplastic appendiceal segments in the rat.</span> <span class="journal_series_title">Neurourol Urodyn</span>, <span class="journal_volume">vol 25</span> <span class="journal_pages">pp 259-267</span>.</div>
<div class="article_info">H Frederiksen, T Davidsson, G Gabella and B Uvelius. <span class="article_issue_date">2007</span>. <span class="article_title">Nerve distribution in rat urinary bladder after incorporation of acellular matrix graft or subtotal cystectomy.</span> (submitted)</div>

Ämnesklassifikation (UKÄ)

  • Urologi och njurmedicin

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