Intestinal motility changes in experimental large bowel obstruction

Bipolar electrodes for recording electrical discharges of colon smooth muscle and strain gages for recording associated contractions of circular muscle were implanted in six rhesus monkeys. After recovery, baseline records were made. The animals then had an obstruction device implanted in sigmoid colon which resulted in progressive compromise of the lumen terminating in complete obstruction after 13 +/- 2 days. Recording were made daily during development of obstruction. As obstruction became more complete, contraction frequency decreased in right colon, increased in left colon proximal to the obstruction, and was unchanged in left colon distal to the obstruction. The frequency of distentions increased in colon proximal to the obstruction but was unchanged distally. Simultaneous mass actions, a complex of nonperistaltic high amplitude contractions and distentions occurring nearly simultaneously throughout the colon which is not seen in normal colon, appeared in colon both proximal and distal to the obstruction and became more frequent as the degree of obstruction progressed. Colon obstruction results in abnormal motility complexes, but not in hyperperistalsis. Mass actions probably are the basis for colic and rushing bowel sounds noted clinically in colon obstruction.     

Kock pouch bladder replacement

Between May 1986 and February 1990, 126 consecutive male patients have undergone lower urinary-tract reconstruction by means of Kock bladder replacement at our institution. The early and late complication rates have been minimal. Good continence has been achieved in 94% of patients during the day and in 84% at night. Our experience with bladder replacement has yielded extraordinary results in terms of patients acceptance. It is anticipated that our experience as well as the experience of others with this surgery will encourage patients afflicted with high-grade bladder cancer and their physicians toward an earlier decision for aggressive therapy by cystectomy while cure is still possible.     

Combined Boari bladder flap-psoas bladder hitch procedure in ureteral replacement

Uncomplicated injuries to the ureter are commonly treated with end-to-end ureteroureterostomy or reimplantation into the bladder. The Boari bladder flap and the psoas bladder hitch have been used separately when distal ureteral replacement is required. In cases of more extensive ureteral damage extending above the pelvic rim, more complex procedures have been performed. These procedures (transureteroureterostomy, intestinal replacement or renal autotransplantation) often represent a considerable surgical challenge and may be associated with numerous complications. Combining the principles of the psoas bladder hitch and Boari flap affords the clinician a means of traversing extensive ureteral defects with standard surgical techniques. We report herein patients with ureteral damage who have undergone replacement of various lengths of ureter with combined psoas hitch/Boari flap procedures. The technique is suitable for traversing ureteral defects at least to the lower pole of the kidney. An obvious advantage is that the replacement utilizes only normal urinary tract, it does not endanger ipsilateral kidney nor contralateral ureter or kidney and can be employed in patients with decreased renal function. In our experience ureteral replacement with the combination of the psoas bladder hitch and Boari bladder flap is an excellent method which is surgically simpler and safer than the other methods described for more extensive ureteral injuries.     

Present status on bladder replacement--colon bladder replacement]

Bladder replacement using a detubularized right colonic segment was successfully performed on 22 male patients with bladder cancer after radical cystectomy. There were 10 early postoperative complications and one of them required reoperation. Urodynamic studies, performed on 16 patients, showed a low pressure reservoir at a large capacity without any involuntary spikes in every case. Of the 16 patients, 4 were nocturnally enuretic and 1 was partially continent. The other 11 patients (68.8%) were totally continent and voiding well, except one who was on intermittent self-catheterization. The incidence of urinary reservoir infections in patients treated with colon bladder replacement was investigated in 18 patients. The incidence rate of bacteriuria was 5.6% and the positive rate of pyuria was 27.8%. The detection rate of bacteriuria and pyuria was significantly low in patients after colon bladder replacement. These findings indicate that colon bladder replacement can be an ideal option for selected patients with bladder cancer.     

Total replacement of bladder and urethra by cecum and appendix in bladder exstrophy

The first case of total bladder and urethral replacement by cecoappendiceal unit was achieved in a five-year-old boy born with bladder exstrophy. Residual vesical and prostatic tissue was utilized to provide continence successfully.     

Cystometry in mice--influence of bladder filling rate and circadian variations in bladder compliance.

Meaningful interpretation of cystometric measurements in experimental animals requires detailed analysis of factors that could affect the results. In the present study, the effect of catheter size and bladder filling rate were studied in detail; in addition, the influence of (day) time on bladder compliance was assessed by cystometry in mice. Bladder reservoir function was independent of the catheter size, when i.v. cannulae with outer diameters of 0.6 and 0.8 mm. were used, but leakage pressure and leakage volume were increased with the larger catheter. Neither the storage capacity nor the bladder wall resistance showed dependence on filling rates above 0.1 ml./min. Below this rate, bladder capacity increased and wall resistance decreased with decreasing filling rate. Furthermore, leakage eventually occurred below 20 mm. Hg with the lower filling rates. Marked diurnal variations in bladder compliance and wall resistance were observed. Maximum storage capacity was observed at 7 p.m. and the reservoir function subsequently decreased to a plateau between 1 a.m. and 1 p.m.     

The use of small intestine in bladder reconstruction

Reconstruction of the bladder is a treatment available to patients who have a diseased or damaged bladder, and small bowel is the most commonly used tissue. Augmentation cystoplasty increases the total bladder capacity, whereas substitution cystoplasty replaces the whole organ. This is either drained through a continent cutaneous stoma or is reanastomosed to the urethra as an orthotopic reconstruction. Although the treatment for invasive bladder cancer has not changed greatly in the last few decades, the use of orthotopic bladder reconstruction allows for a great improvement in the quality of life for patients who undergo cystectomy. These reconstructive techniques can also be offered to patients with other forms of pelvic malignancy that involve the bladder.     

Right colocystoplasty for bladder replacement

Total bladder replacement by an ileoascending colonic segment with adjunctive use of intermittent self-catheterization and secondary insertion of an artificial sphincter has been selectively employed in a group of male patients undergoing cystectomy for localized invasive bladder cancer and disabling interstitial cystitis. This bowel segment offers a capacious reservoir, an effective antireflux barrier, and a consistent tension-free colourethral or coloprostatic anastomosis. Mucous plug catheter obstruction is rarely a problem in this reservoir during the early postoperative course.     

Intestinal motility and the serum motilin levels after abdominal surgery

Correlation of intestinal motility and serum motilin after abdominal surgery was investigated experimentally and clinically. The results were summarized as follows: The recovery of intestinal motility was faster in the dogs simply laparotomized than gastrectomized. The recovery of the small intestinal motility was followed by that of the large intestinal motility in the dogs. The intravenous infusion of the synthetic motilin markedly stimulated the intestinal motor activity in early postoperative period. Serum motilin levels significantly dropped one after abdominal surgery and rose again both in the dogs and the patients. The rate of increase of serum motilin levels at the postoperative period closely correlated with the recovery of the intestinal motility both in the dogs and the patients, that is, the higher the rate of increase was, the faster the recovery was.