Clinical Experience of Urinary Bladder Substitution with Intestinal Seromuscular Grafts

Abstract

Bladder substitutes have been performed in three patients and an ileal conduit in one patient using intestinal seromuscular grafts. All the substitutes had a sufficient capacity in the first postoperative period, but gradually contracted and had to be removed. The muscle surface facing the lumen became only partially epithelialized.

Absorption studies showed a considerable chloride ion migration across the intestinal mucosa in conventional intestinal bladder substitutes. From substitutes of seromuscular grafts the absorption was much less and similar to the normal bladder.

Electrolyte disturbances after urinary diversion to isolated intestinal loops is not a great problem in man. Such disturbances are seen, however, when the patients have an impaired renal function. There is therefore a need for a “non-absorbent” substitute for the urinary bladder.

The experiences presented here show that bladder substitution with intestinal seromuscular grafts in man may be satisfactory with regard to the absorptive qualities. However, the operation cannot be recommended, because the substitutes contract with fibrosis in their walls—a condition comparable to interstitial cystitis.