Objective To investigate the biocompatibility of acellular urinary bladder submucosa (AUBS). Methods The acellular collagen matrix of human urinary bladder submucosa was developed using freeze-thawed enzymatic treatment and freeze-drying technique. Human oral keratinocytes were cultured and seeded on AUBS at a density of 2×106/ml in vitro.The proliferation of the cells were observed. Pockets were created in the abdominal muscle wall of 18 SD rats. AUBS in size 1 cm×1 cm was implanted into the pocket. The grafts were observed by light microscope 3, 6, 10, 14, 21 and 28 days after operation. Results AUBSmainly consisted of collagen fibers with a three-dimensional network structure. After the oral keratinocytes were seeded, continous oral epithelium layer was formed on the surface of AUBS after 10 days in vitro. Histological observation of the grafted AUBS showed progressive cell infiltration at 6 days. New capillaries formed at 14 days. The collagen fibers arranged regularly at 28 days after implantation. Conclusion Freeze-dried AUBS may be used as a suitable scaffold for tissue regeneration, which can induce cell proliferation both in vivo and in vitro and has good biocompatibilty.
Objective To explore an effective method of culturing the canine bladder smooth muscle cells, observe the morphological characteristics of the bladder smooth muscle cells growing on acellular small intestinal submucosa（SIS） and offer an experimental basis for reconstruction of the bladder smooth muscle structure by the tissue engineering techniques. Methods The enzymetreatment method and the explant method were respectively used to isolate and harvest the canine bladder smooth muscle cells, and then a primary culture of these cells was performed. The canine bladder smooth musclecells were seeded on the SIS scaffold, and the composite of the bladder smooth muscle cells and the SIS scaffold were co cultured for a further observation. At 5,7 and 9 days of the co culture, the specimens were taken; the bladder smooth muscle cells growing on the SIS scaffold were observed by the hematoxylin staining, the HE staining, and the scanning electron microscopy. The composite of the bladder smooth muscle cells on the SIS scaffold was used as the experimental group, and the bladder smooth muscle cells with no SIS were used as the control group. In each group, 9 holes were chosen for the seeded bladder smooth muscle cells, and then the cells were collected at 3, 5 and 7 days for the cell counting after the enzyme treatment. Morphological characteristics of the cells were observed under the phase contrast microscope and the transmission electron microscope. Expression of the cell specific marker protein was assessed by the immunohistochemical examinaiton. The proliferation of the cells was assessed by the cell counting after the seeding on the SIS scaffold. Results The primary bladder smooth muscle cells that had been harvested by the enzyme treatment method were rapidly proliferated, and the cells had good morphological characteristics. After the primary culture in vitrofor 5 days, the bladder smooth muscle cells grew in confluence. When the bladder smooth muscle cells were seeded by the explant method, a small amount of the spindleshaped bladder smooth muscle cells emigrated from the explant at 3 days. The cells were characterized by the welldeveloped actin filaments inthe cytoplasm and the dense patches in the cell membrane under the transmissionelectron microscope. The immunohistochemical staining showed the canine bladdersmooth muscle cells with positive reacting α actin antibodies. The bladder smooth muscle cells adhered to the surface of the SIS scaffold, growing and proliferating there. After the culture in vitro for 5 days, the smooth muscle cells covered all the surface of the scaffold, showing a singlelayer cellular structure. The cell counts at 3, 5 and 7 days in the experimental group were（16.85±0.79）×105，（39.74±2.16）×105 and （37.15±2.02）×105, respectively. Thecell counts in the control group were（19.43±0.54）×105，（34.50±1.85）×105 and （33.07±1.31）×105, respectively. There was a significant difference between the two groups at 5 days （P＜0.05）. ConclusionWith the enzyme treatment method, the primarily cultured canine bladder smooth muscle cells can produce a great amount of good and active cells in vitro. The acellular SIS can offer an excellent bio scaffold to support the bladder smooth muscle cells to adhere and grow, which has provided the technical foundation for a further experiment on the tissue engineered bladder reconstruction.
Objective To study the advance in the treatment of atonic bladder after spinal cord injury. Methods The rencent literature concerned was extensively reviewed and some methods of therapy for atonic bladder were introduced. Results No effective method of therapy was found for atonic bladder after spinal cord injury. When compared with clean intermittent catheterization, pharmacologic therapy, compressive micturition and detrusor function reconstruction, the establishment of an artificial bladder reflex arc may have a potential of controllable micturition. Conclusion To establish an artificial bladder reflex may provide an update of current therapeutic concepts for atonic bladder after spinalcord injury.
Objective To study the microstructural change of detrusor muscle and neuromuscular junction (NMJ) after bladder functional reconstruction for atonic bladder caused by medullary cone injury and to discuss the feasibility of bladder functional reconstruction for improving the detrusor muscle degeneration. Methods A total of 104 adult female Sprague-Dawley rats (weighing, 200-250 g) were randomized divided into 3 groups: normal group (n=8), control group (n=48), and experimental group (n=48). No treatment was given in normal group; the medullary cone injury was established by sharp transection of spinal cord at L4, 5 levels in control group; and the anastomosis of bilateral L5 ventral root (VR)-S2 VR and L5 dorsal root (DR)-S2 DR was performed for bladder functional reconstruction after modeling of medullary cone injury in experimental group. After operation, the survival condition of rats was observed. At 3 days and 3 consecutive days before 1, 2, 3, 4, 5, and 6 months after operation, the residual urine volume was measured; at 1, 2, 3, 4, 5, and 6 months after operation, the detrusor muscle was harvested to measure the muscle fiber cross-sectional area by HE staining, to calculate the percentage of connective tissue by Masson trichrome staining, and to observe the ultrastructure of the detrusor muscle and the NMJ by transmission electron microscope (TEM). Results Eleven rats were supplemented because of death after operation. In control group, a significant increase of the residual urine volume was observed with the extension of time (P lt; 0.05); in experimental group, an increase was observed at the first 3 months after operation, and then gradually decreased, showing significant differences between the other time point (P lt; 0.05) except between at 3 days and at 5 months after operation (P gt; 0.05); there was significant difference between control and experimental groups at other each time point (P lt; 0.05) except at 3 days, 1 month, and 2 months (P gt; 0.05). HE staining and Masson trichrome staining indicated that the muscle fibers arranged in disorder with gradually aggravated atrophy and gradually increased connective tissue in control group, while the shape of the detrusor muscle recovered with no increased connective tissue at 4, 5, and 6 months after operation in experimental group; there was significant difference in cross-sectional area of detrusor muscle and percentage of connective tissue between normal group and experimental group, and between normal group and control group at each time point (P lt; 0.05). In control group, the cross-sectional area of detrusor muscle decreased and the percentage of connective tissue increased with the extension of time (P lt; 0.05). In experimental group, the cross-sectional area of detrusor muscle decreased at the first 3 months and then increased, and the percentage of connective tissue increased slowly with the extension of time. There was no significant difference of cross-sectional area of detrusor muscle at the first 3 months between control and experimental groups (P gt; 0.05), but the values in experimental group were significantly higher than those in control group at 4, 5, and 6 months after operation (P lt; 0.05). There were significant differences of the percentage of connective tissue between control and experimental groups at each time point (P lt; 0.05). In control group, the amount of synaptic vesicles decreased in the NMJ with time passing; vacuole like structure was observed in NMJ at 3 months; there was almost no nerve ending at 6 months. In experimental group, the amount of synaptic vesicles decreased at 1 and 3 months after operation, but obviously increased at 6 months. Conclusion The reconstruction of bladder function with L5 nerve roots above the paraplegic plane can effectively inhibit the degeneration of detrusor muscle and improve its microstructural changes after medullary cone injury.
Objective To observe the effect of selective sacral rhizotomy in treating spastic bladder after spinal cord injury and to explore the mechanism and the best surgical method of different sacral rhizotomies. Methods The spastic bladder models were established in 12 male dogsand were divided into 4 groups according to the different rhizotomies of the sacral nerve as the following: rhizotomy of the anterior root of S2(group A), rhizotomy of the anterior root of S2 and half of the anterior root of S3(group B), rhizotomy of the anterior roots of S2 and S3(group C), and total rhizotomy of the nerve roots of S2-4 (group D). By urodynamic examination and electrophysiological -observation, the changes of all functional data were recorded and comparedbetween pre-rhizotomy and post-rhizotomy to testify the best surgical method. In clinical trial, according to the results of the above experiments, rhizotomy of the anterior root of S2 or one of the halfanterior root of S3 were conducted on 32 patients with spastic bladder after spinal cord injury. The mean bladder capacity, the mean urine evacuation and the mean urethra pressure were (120±30), (100±30)ml and (120±20) cm H2 O, respectively before rhizotomy. Results After rhizotomy, the bladder capacity in 4 groups amounted to (150±50), (180±50), (230±50), and (400±50) ml, respectively; and the urine evacuation volume were (130±30), (180±50), (100±50) and (50±30)ml, respectively. In the treated 32 patients, the mean bladder capacity were raised to 410 ml, and the mean urine evacuation volume were also increased to 350 ml. Incontinence of urine disappeared in all patients. After 22-month follow-up on 13 patients, no recurrence was observed. Conclusion The effectof selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies.
目的:探讨基层医院前列腺增生并膀胱结石的微创治疗方法。方法:联合经尿道等离子双极电切与耻骨上小切口治41例前列腺增生症并膀胱结石。结果:手术时间40~110min, 平均55min,术后3d拔造瘘管, 第5~6天拔除尿管,排尿通畅, 无电切综合征(TURS)、大出血等并发症,住院时间7±1.5天。数字疼痛评分0~6,平均3.5。结论：等离子体双极电切结合耻骨上小切口是治疗前列腺增生并膀胱结石的一种快速、安全有效、微创的手术方法,值得在基层医院推广。
ObjectiveTo evaluate the clinical effect of early and deferred intravesical instillation in the treatment of cystitis glandularis after transurethral resection (TUR). MethodsWe retrospectively analyzed the clinical data of 95 patients with cystitis glandularis during February 2007 to April 2012. Among them, 37 patients underwent the first intravesical instillation within 24 hours after transurethral resection (group A), while the others underwent the same treatment within a week (group B). Then, intravesical instillation in all patients were carried out once every week for 8 weeks, and after that, it was carried out once every month for 5 to 10 months. All the patients were followed up for 12 to 16 months. The cure rate, improvement rate, total effective rate, recurrence rate and incidence of adverse events associated with therapy were observed. ResultsRecovery rate, improvement rate, side effects were observed in group A and B respectively, and there was no significant difference between the two groups (P>0.05). But there was significant difference in the total effective rate and recurrence rate (P<0.05). ConclusionThe first intravesical instillation within 24 hours after transurethral resection in the treatment of cystitis glandularis can improve curative effect and lower recurrence rate, without the increase of side effects.
To introduce a micturition alert device dedicated to neurogenic bladders. Methods The design and mechanism of the micturition alert device were explained, the effectiveness was tested in a cranine experiment. Results The micturition alert device consisted of a permanent magnet sutured on the anterior bladder wall and a warning unit sutured on theinferior abdominal wall. The warning unit was assembled with a compass-l ike switch, a power supply, a buzzer and a power switch. Bladder volume determined the position of the magnet which determined the magnetic field at the point of the warning unit. The change of magnetic field was read by the warning unit. With increasing bladder volume from initial state to 200 mL in 8 dogs, the magnet moved cranially 32.8 mm averagely (from 31.3 mm to 34.1 mm) and the hand of warning unit turned 52° (from 47° to 57°). The value of the warning unit was correlated positively to the bladder volume (r =1.0, P lt; 0.01）. If the desired bladder volume was determined as 150 mL to activate the warning unit to alarm in advance, the fullness of bladder was 147.6 mL averagely from135 mL to 160 mL, with an error less than 15 mL (10%). Conclusion The micturition alert device including a warning unit and permanent magnet could monitor bladder volume continuously and alarm in time for the patients with loss of micturition desire. It is simple, easily-made, cheap and conveniently used. It is worth of further study.
Objective To investigate the biocompatibil ity of sil ica gel embedded permanent magnets of themicturition alert device dedicated to neurogenic bladder. Methods According to the national standards of biologicalevaluation of medical equipment (GB/T 16886), Shanghai Biomaterial Research and Test Center was confided to evaluate the biocompatibil ity of sil ica gel embedded permanent magnets both in vitro and in vivo, including cytotoxicity test, sensitization test, primary skin irritant test and acute general toxicity test. The cytotoxicity test was performed according to the agar diffusion method. The L929 cell discoloration index and cell lysis index were counted at 24 hours after the action of the specimen. The sensitization test was performed according to the maximal dose method. The skin response was evaluated in 30 male albino guinea-pigs at 24 and 48 hours after the routine induction and provocation of leaching l iquors of the specimen. The primary skin irritant test was evaluated in 2 male healthy New Zealand rabbits according to the local tissue response at 24, 48 and 72 hours after intradermal injection of leaching l iquors of the specimen. The acute general toxicity test was evaluated in 10 male Kumming mice musculus albus according to animal condition at 4, 24, 48 and 72 hours after injection of leaching l iquors of the specimen through the caudal vein. Both the general reaction of canines and the pathology of the local bladder walls were observed at 2, 4 and 8 weeks after a permanent magnet was fixed on the anterior wall of urinary bladder in three canines. Results No sensitization, no stimulation and no acute general toxicity were observed except sl ight cytotoxicity to sil ica gel embeddedpermanent magnets. After implantation of a permanent magnet, the canines showed excellent tolerace, which manifested as no abnormal ity in spirit, appetite, urine and stool, healed wounds and no infection. Adhesions occurred between the epiploon and the bladder wall around the permanent magnet in two canines at 2 and 4 weeks, and between the lower abdominal wall and the bladder wall around the permanent magnet in the other canine at 8 weeks. The local bladder wall below permanent magnet was thickened, the fibrous capsule around the permanent magnet was thin, but the bladder mucosa was normal. Inflammatory reaction such as congestion, edema and inflammatory cells lessened from the serosa layer to the mucosa layer microscopically. Conclusion Sil ica gel embedded permanent magnets used in the micturition alert device dedicated to neurogenic bladde has excellent biocompatibil ity and meet the criteria for cl inical appl ication．