LAPAROSCOPIC LASER-ASSISTED BLADDER AUTOAUGMENTATION

Objectives. The purpose of this study is to examine the feasibility of performing a laparoscopic bladder autoaugmentation and to assess the urodynamic characteristics of an autoaugmented bladder. Methods. Lapar oscopic bladder autoaugmentation was performed in 9 female canines (20 to 30 kg). Following laparoscopic access to the peritoneal cavity, a midline bladder seromyotomy was performed using the potassium titanyl phosphate 532 nm laser. This produced a large bladder diverticulum. Ch anges in bladder volume and compliance were quantified over a 3-month period of follow-up. Results. Urodynamic evaluation demonstrated an in crease in bladder capacity 6 weeks postoperatively in 8 of 9 dogs, wit h an average volume increase of 45%. Bladder compliance improved in 7 of 9 dogs with an average increase in compliance of 67%. Three months postoperatively, bladder capacity remained increased in 5 of 9 dogs, w ith an average increase in volume of only 5.3%. An improvement in comp liance was Sustained in 5 of 9 animals with an average increase of 13. 9%. Laparoscopic exploration revealed grossly normal bladders with adh esions of omentum to the seromyotomy site in all canines and the anter ior abdominal wall in 2 of 9 canines. Histologically, the seromyotomy site was devoid of muscle with an intact urothelium and a proliferatio n of loose connective tissue. Conclusions. The technique of laparoscop ic bladder autoaugmentation can be performed easily in the canine mode l. Although results at 6 weeks show significant improvement, the longe r term, 3-month results were not statistically significant. This techn ique has the potential to offer a minimally invasive correction for pa tients with low-capacity, high-pressure bladders that have failed phar macologic treatment.