Laparoscopic augmentation cystoplasty using the novel biomaterial Surgisis(TM): Small-intestinal submucosa

Background and Purpose: Urinary bladder augmentation is indicated for diver se conditions, including neurogenic bladder, cancer resection, spinal cord injury, and congenital anomalies. The ideal cystoplasty material is yet to be described, Native gastrointestinal segments commonly used are limited by leakage and small-bowel obstruction, metabolic/nutritional abnormalities, calculi, and malignancy, This study assessed laparoscopic bladder augmentat ion with porcine small intestinal submucosa (SIS), Materials and Methods: Five female pigs (<25 kg) were prepared for surgery under general anesthesia. After Veress needle insufflation, a main 10-mm tr ocar was placed in the midline for the laparoscope, with two lateral 10-mm ports added for operative instruments. The bladder dome was incised, and a patch of SIS was sewn into the bladder using running 2-0 Vicryl, Three anim als served as technical studies. Two additional sows underwent long-term su rvival surgery: one undiverted and one diverted via a Stamey suprapubic: ca theter, Results: There were no operative losses, The mean operative time was 140 mi nutes, The SIS graft held the sutures without tearing. Laparoscopic survey revealed no urine leaks-at bladder closure, All five animals voided postope ratively, Urinary extravasation was evident in the three undiverted techniq ue animals, In the other two sows, cystoscopy at 7 days showed intact sutur e lines without evidence of urinary extravasation and with normal vesicular volumes. Tissue growth was evident, but the graft margins were still disce rnible. Conclusions: Laparoscopic bladder augmentation was possible using SIS but a t minimal volumes, There were no operative complications; however, the mate rial was difficult to deploy and may benefit from application of an absorba ble scaffold. Postoperative urinary drainage is necessary, Further studies will optimize the graft configuration for maximal augmentation.