Detrusor-myoplasty, innervated rectus muscle transposition study, and functional effect on the spinal cord injury rat model
✍ Scribed by Michael B. Chancellor; David A. Rivas; Rafael Acosta; Michael J. Erhard; John Moore; Steven K. Salzman
- Publisher
- John Wiley and Sons
- Year
- 1994
- Tongue
- English
- Weight
- 676 KB
- Volume
- 13
- Category
- Article
- ISSN
- 0733-2467
No coin nor oath required. For personal study only.
✦ Synopsis
The purpose o f this investigation was t o determine the feasibility of striated muscular augnientation of the urinary bladder (detrusor-niyoplasty. DMP). Initial studies. transposition. and bladder wrap using several distinct musck groups was attempted in kihoratory rats, goats, and fresh human cadavers. The rectus abdominus muscle was found to be best wited t o completely encompass the bladder with an intact neural and vascular supply. The technique was then applied in a rat model of spinal cord injury (SCI).
Modified Tarlov ratings were employed t o assess neurologic function 30 days after SCI. The median final neurological score o f SCI rats with and without DMP was 4 and 5 . respectively. Sham-operated SCI (control) rats, with and without DMP. both had normal final Tarlov scores of I2 ( P < 0 . 0 5 ) . Muscle blotd flow values lor the flap and the contralateral undissected rectus muscles were not significantly different (97 ? 34 and 105 t 40 nil/100 g tissue/min, reyxctively. P = 0.47). Postoperatively. n o bowel o r abdominal wall functional deficit% were apparent. The rotated muscular flap remained innervated and vascularixd.
Analysis of 24 hr micturition patterns demonstrated no differences in oral fluid intake/ 24hr. voided volume/24hr. and ratio o f number of micturitions during the night vs. day among thc tour groups: ( I ) control (neither SCI nor DMP), (2) DMP only, (3) SCI only. and ( 4 ) SCI with DMP. Spinal cord injured rats with and without detrusor-myoplasty demonstrated a significant decrease in the number of micturitions/24hr. an increased volume per micturition. and greater largest and smallest micturition volumes ( P < 0.0s) when compared t o controls. The micturition patterns among SCI rats with and without DMP were similar, as were non-SCI animals with and without DMP. This is the first report of the principle and technique of detrusor-myoplasty. Dissection of rats. goats. and human cadavers revealed that a vascularized and innervated rectus muscle flap can be rotated into the pelvis and wrapped around the bladder without tension. Significant loss o f bladder capacity did not occur with skeletal muscle adaptation. Detrusormyoplasty may be applicable for patients with an areflexic detrusor and non-intact sacral motor roots who are not candidates for ( ' IWJ Wtlcy-Lt\. Inc I anterior root neurostimulation.