PHOTOCHEMICAL ABLATION OF INTESTINAL-MUCOSA FOR BLADDER AUGMENTATION

Complications associated with enterocystoplasty include mucus producti on, electrolyte abnormalities, infections, stones and cancer at the ve sicoenteric anastomosis. Removal of the intestinal mucosa with subsequ ent urothelialization may obviate these problems. We describe a unique approach whereby photodynamic therapy is used to de-epithelialize an ileal segment before augmentation. Enterocystoplasty was performed in 32 female Fischer 344 rats using a 1.5 cm. patch of terminal ileum. Of the 32 rats 24 survived at least 6 weeks before euthanasia. The exper imental group (10 rats) received hematoporphyrin derivative intravenou sly 24 hours before surgery. The ileal patch was treated with red ligh t for 20 minutes and then used for augmentation. There were 3 control groups, including 1 group of 5 rats that underwent augmentation alone, while the other 2 groups were augmented but received either light tre atment (4 rats) or hematoporphyrin derivative (5 rats). Histological a nalysis revealed urothelialization of the augments treated with hemato porphyrin derivative and light, which did not occur in the controls. T he preoperative and postoperative bladder capacities increased substan tially in all groups. Mucus production and bacterial colonization were reduced while stone formation increased in the treated animals.