By Robin DeMattia
NEW YORK (Reuters) -- Physicians have developed a surgical technique
that takes muscle from the back to strengthen
bladder muscle, thus restoring bladder function.
Dr. Arnulf Stenzl and colleagues from the University of Innsbruck
Medical Centre in Austria performed the operation on two
men who had difficulty controlling their bladders due to spinal cord
injury and a third who had bladder problems after prostate
surgery. The surgeons used muscle taken from each man's lower back to
help restore the bladder's ability to contract.
One patient experienced a few urinary-tract infections during the first
few months after surgery, but overall the procedures went
well.
In the procedure, muscle from the latissimus dorsi back muscle is used
to "functionally restore" the bladder detrusor muscle,
which helps expel urine from the bladder.
"None of our patients have reported any problems either at the donor
(lower back) or the recipient (bladder) site," the
physicians report in The Lancet. The technique "has proved to be
successful for the three patients in our study."
Stenzl and his colleagues based their bladder technique on other forms
of "free functioning muscle transfer," which is used to
reconstruct muscles in the arms, legs, abdominal wall, and face.
"We used only autologous material for this partial bladder substitution,
which is material from one's own body that can be
spared without major morbidity instead of using expensive... artificial
material," Stenzl explained to Reuters Health. "The muscle
which is transplanted to the bladder is hooked up to a nerve of the
abdominal musculature that is used for straining. Even under
normal circumstances, anybody who can't void applies this abdominal
straining as a reflex."
"Therefore, these new parts need a minimum of training to use their new
muscle for voluntary micturition (urination). No outside
or implanted electrical stimulation is needed for the muscle
contraction/bladder emptying," the researcher added.
"The substitution of involuntary bladder muscle with voluntary skeletal
muscle is a major step towards total and functional
bladder reconstruction," he said, and is a good alternative to another
procedure used to treat a dysfunctional bladder: using
intestinal segments to create a new bladder. SOURCE: The Lancet
(1998;351:1483-1485)