- Email: [email protected]
1260 BLADDER REPLACEMENT ACCORDING TO “VESCICA ILEALE PADOVANA (VIP)” TECHNIQUE USING THE NEW V-LOC® AUTOSTATIC SUTURE
e516
THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
1260
1261
BLADDER REPLACEMENT ACCORDING TO “VESCICA ILEALE PADOVANA (VIP)” TECHNIQUE USING THE NEW V-LOC® AUTOSTATIC SUTURE
SCAFFOLD WITH NEUROTROPHIC AND TOPOGRAPHIC FACTORS FOR IMPROVED AUTONOMIC INNERVATION FOR BLADDER ENGINEERING
Alessio Filianoti*, Marco Racioppi, Daniele D’agostino, Luca Di Gianfrancesco, Pierfrancesco Bassi, Rome, Italy
Srinivas Madduri*, Rita Gobet, Tullio Sulser, Daniel Eberli, Zurich, Switzerland
INTRODUCTION AND OBJECTIVES: The phase of creation and reconfiguration of the ileal neobladder after radical cistectomy affects in a decisive way the length of operation and the rate of early complications. The use of a self-blocking suture is the ideal path to improve and shorten this phase. We are going to introduce the “Vescica Ileale Padovana (VIP)” technique, using the V-LOC® device (Glycomer™ 631), a new autostatic suture available without necessity of making knots. METHODS: In our Department we used the new self-blocking reabsorbable suture V-LOC® on 17 pts (14 m & 3 f) undergoing radical cistectomy and orthotopic ileal bladder replacement according to the VIP technique. After cistectomy performed according to usual technique, we collected 45 or 55 cm of ileum necessary for VIP reconstruction. We used the V-Loc® 3/0 stitch for the entire reconstruction, making a one-layer running suture on both the posterior and the anterior wall. We evaluated the time of reconstructive surgery, the cost of suture material and the perfect hydraulic closure of the ileal bladder performing an hydraulic test made at the end of reconstruction and a voiding cistography 12 days and 3 month after surgery. We used as control group 17 patients with bladder replacement using Standard Vicryl 3/0 stitches in double layer suture using the same paramethers. RESULTS: We reported: - Significant surgical time reduction. In our experience classic surgical reconstructive phase takes about 100 minutes to be completed. Using the V-Loc® device, surgical time has been reduced at least 30 minutes. - Substantial costs variation. We used 26/30 Vicryl 3/0 spools versus 4 V-Loc® 3/0 spools with a total charge of 152$ versus 100$. - Significant differences in terms of surgical outcomes: the voiding cystography performed 12 days & 3 month after surgery, showed a perfect hydraulic closure of the ileal bladder in all V.I.P. pts. CONCLUSIONS: The reconstruction of the orthotopic ileal neobladder using the self-blocking stitch has showed effective and safe results. The procedure has been more simple and faster. The hydraulic tests made at the end of reconstruction showed a perfect hydraulic closure of the ileal bladder. The results were confirmed by a voiding cystography. So no early or late suture dehiscences have been recorded. We’ve also noticed a good Bladder capacity ( ⬎300 ml).
INTRODUCTION AND OBJECTIVES: Many urologic conditions require surgical reconstruction of the bladder, which is currently done with autologous bowel tissue. Tissue engineering of tissues is a promising technique without harvest site morbidity. Although tissue formation has been shown, physiologic contractions have never been demonstrated, mainly due to the lack of proper innervation. In this research we developed a bladder tissue biomaterial with engineered structural and biochemical microenvironment, which provides guidance of autonomic axonal regeneration for restoring functional uro-neuro anatomy. METHODS: In vitro model system was established based on chicken embryonic sympathetic ganglionic explants and electrospun fibers as topographical guidance structures. Effect of nerve growth factor (NGF) and nanostructures on axonal outgrowth and guidance was evaluated in vitro. A nanofibers based delivery system was fabricated by electrospinnig technology which allows to tailor the NGF release kinetics ensuring the optimal spacio-temporal therapeutic delivery of NGF. 5 different polymeric membranes; collagen (Col), silk fibroin (SF), Col75: SF25, Col50: SF50 and Col75:SF25 were prepared from 500 ml of 10% polymeric solution. Corresponding nanofibers were electrospun on the dry polymeric membrance from solutions preloaded with NGF (500 ng/mg scaffold). Growth factors release kinetics and bioactivity of NGF release was analysed over 30 days. RESULTS: Nanostructured topography guided and enhanced axonal growth from sympathetic ganglions in the presence of exogenously supplemented NGF (1-10 ng/ml). Polymeric composite construct integrated with nanofibrous delivery system for controlled release of NGF were successfully fabricated and characterized. All 5 different collagen and silk fibroin delivery systems showed sustained release of biologically active NGF with significantly different release kinetics. Bioactivity of NGF release over 30 days was confirmed by activated PC12 cells. CONCLUSIONS: Polymeric fibrous scaffolds with integrated nanofibrous delivery system releasing neurotrophic factors significantly support axonal guidance and ingrowth of autonomic axons. This biomaterials holds great promise for functional bladder tissue engineering through guided axon regeneration. Source of Funding: We acknowledge eleonora stifstung for the enabling financial support.
1262 EARLY URINARY DIVERSION WITH ILEAL CONDUIT AND VESICOVAGINOSTOMY IN THE TREATMENT OF RADIATION CYSTITIS DUE TO CARCINOMA CERVIX: John Banerji*, Vellore, India
Source of Funding: None
INTRODUCTION AND OBJECTIVES: Radiation cystitis following radiation therapy for carcinoma cervix causes significant morbidity including recurrent haematuria often requiring multiple admissions and transfusions, in addition to poor quality of life, due to severe frequency as a result of reduced bladder capacities. We propose an algorithm to decide on early diversion, with or without vesicovaginostomy. METHODS: This was a retrospective study spanning from Jan 1998 to December 2011 with the approval of the institutional review board. Electronic data review of patients who received radiotherapy for carcinoma cervix was performed. All patients who had symptoms suggestive of radiation cystitis according to the common toxicity criteria viz. burning micturition, increased frequency, haematuria, incontinence, renal failure were initially evaluated. They were then categorized according to the RTOG (Radiation therapy oncology group) grading for radiation cystitis, into the mild (Gr 1 and 2) cystitis, and the
THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
1260
1261
BLADDER REPLACEMENT ACCORDING TO “VESCICA ILEALE PADOVANA (VIP)” TECHNIQUE USING THE NEW V-LOC® AUTOSTATIC SUTURE
SCAFFOLD WITH NEUROTROPHIC AND TOPOGRAPHIC FACTORS FOR IMPROVED AUTONOMIC INNERVATION FOR BLADDER ENGINEERING
Alessio Filianoti*, Marco Racioppi, Daniele D’agostino, Luca Di Gianfrancesco, Pierfrancesco Bassi, Rome, Italy
Srinivas Madduri*, Rita Gobet, Tullio Sulser, Daniel Eberli, Zurich, Switzerland
INTRODUCTION AND OBJECTIVES: The phase of creation and reconfiguration of the ileal neobladder after radical cistectomy affects in a decisive way the length of operation and the rate of early complications. The use of a self-blocking suture is the ideal path to improve and shorten this phase. We are going to introduce the “Vescica Ileale Padovana (VIP)” technique, using the V-LOC® device (Glycomer™ 631), a new autostatic suture available without necessity of making knots. METHODS: In our Department we used the new self-blocking reabsorbable suture V-LOC® on 17 pts (14 m & 3 f) undergoing radical cistectomy and orthotopic ileal bladder replacement according to the VIP technique. After cistectomy performed according to usual technique, we collected 45 or 55 cm of ileum necessary for VIP reconstruction. We used the V-Loc® 3/0 stitch for the entire reconstruction, making a one-layer running suture on both the posterior and the anterior wall. We evaluated the time of reconstructive surgery, the cost of suture material and the perfect hydraulic closure of the ileal bladder performing an hydraulic test made at the end of reconstruction and a voiding cistography 12 days and 3 month after surgery. We used as control group 17 patients with bladder replacement using Standard Vicryl 3/0 stitches in double layer suture using the same paramethers. RESULTS: We reported: - Significant surgical time reduction. In our experience classic surgical reconstructive phase takes about 100 minutes to be completed. Using the V-Loc® device, surgical time has been reduced at least 30 minutes. - Substantial costs variation. We used 26/30 Vicryl 3/0 spools versus 4 V-Loc® 3/0 spools with a total charge of 152$ versus 100$. - Significant differences in terms of surgical outcomes: the voiding cystography performed 12 days & 3 month after surgery, showed a perfect hydraulic closure of the ileal bladder in all V.I.P. pts. CONCLUSIONS: The reconstruction of the orthotopic ileal neobladder using the self-blocking stitch has showed effective and safe results. The procedure has been more simple and faster. The hydraulic tests made at the end of reconstruction showed a perfect hydraulic closure of the ileal bladder. The results were confirmed by a voiding cystography. So no early or late suture dehiscences have been recorded. We’ve also noticed a good Bladder capacity ( ⬎300 ml).
INTRODUCTION AND OBJECTIVES: Many urologic conditions require surgical reconstruction of the bladder, which is currently done with autologous bowel tissue. Tissue engineering of tissues is a promising technique without harvest site morbidity. Although tissue formation has been shown, physiologic contractions have never been demonstrated, mainly due to the lack of proper innervation. In this research we developed a bladder tissue biomaterial with engineered structural and biochemical microenvironment, which provides guidance of autonomic axonal regeneration for restoring functional uro-neuro anatomy. METHODS: In vitro model system was established based on chicken embryonic sympathetic ganglionic explants and electrospun fibers as topographical guidance structures. Effect of nerve growth factor (NGF) and nanostructures on axonal outgrowth and guidance was evaluated in vitro. A nanofibers based delivery system was fabricated by electrospinnig technology which allows to tailor the NGF release kinetics ensuring the optimal spacio-temporal therapeutic delivery of NGF. 5 different polymeric membranes; collagen (Col), silk fibroin (SF), Col75: SF25, Col50: SF50 and Col75:SF25 were prepared from 500 ml of 10% polymeric solution. Corresponding nanofibers were electrospun on the dry polymeric membrance from solutions preloaded with NGF (500 ng/mg scaffold). Growth factors release kinetics and bioactivity of NGF release was analysed over 30 days. RESULTS: Nanostructured topography guided and enhanced axonal growth from sympathetic ganglions in the presence of exogenously supplemented NGF (1-10 ng/ml). Polymeric composite construct integrated with nanofibrous delivery system for controlled release of NGF were successfully fabricated and characterized. All 5 different collagen and silk fibroin delivery systems showed sustained release of biologically active NGF with significantly different release kinetics. Bioactivity of NGF release over 30 days was confirmed by activated PC12 cells. CONCLUSIONS: Polymeric fibrous scaffolds with integrated nanofibrous delivery system releasing neurotrophic factors significantly support axonal guidance and ingrowth of autonomic axons. This biomaterials holds great promise for functional bladder tissue engineering through guided axon regeneration. Source of Funding: We acknowledge eleonora stifstung for the enabling financial support.
1262 EARLY URINARY DIVERSION WITH ILEAL CONDUIT AND VESICOVAGINOSTOMY IN THE TREATMENT OF RADIATION CYSTITIS DUE TO CARCINOMA CERVIX: John Banerji*, Vellore, India
Source of Funding: None
INTRODUCTION AND OBJECTIVES: Radiation cystitis following radiation therapy for carcinoma cervix causes significant morbidity including recurrent haematuria often requiring multiple admissions and transfusions, in addition to poor quality of life, due to severe frequency as a result of reduced bladder capacities. We propose an algorithm to decide on early diversion, with or without vesicovaginostomy. METHODS: This was a retrospective study spanning from Jan 1998 to December 2011 with the approval of the institutional review board. Electronic data review of patients who received radiotherapy for carcinoma cervix was performed. All patients who had symptoms suggestive of radiation cystitis according to the common toxicity criteria viz. burning micturition, increased frequency, haematuria, incontinence, renal failure were initially evaluated. They were then categorized according to the RTOG (Radiation therapy oncology group) grading for radiation cystitis, into the mild (Gr 1 and 2) cystitis, and the