First experiences of bladder augmentation with a surgisis (SIS) - transplant -
Purpose Inadequate capacity and compliance of the infantile urinary bladder often needs surgical treatment with an augmentation. Under the problematic aspects of conventional methods, Surgisis (SIS), a “Small Intestinal Submucosa” preparation has been used in our clinic over the last two years. Material and methodsS “SIS” is a biomaterial from the small intestine of the pig, which COOK Co. offers in a compatible form. The end product is a three-dimensional Extra-Cellular Matrix (ECM) consisting of collagen, non-collagenic proteins and other biomolecules including glycoproteins. Five children aged nine months to ten years, with different starting indications, have so far been augmented with “SIS”. Congenital microbladders, in a child with Silver-Russel-Syndrome, a contracted bladder after a failed reconstruction performed elsewhere and a case of a therapy resistant vesical fistula comprise the major clientele. After a median line incision of the urinary bladder, a 4-layer patch with 4x0 resp. 5x0 PDS continuous and approx. 5 mm overlapping edge, was attached to prevent contraction. Impermeability was achieved with a tachofleece segment (BAXTER) and collagen gluten. Results 1. The postoperative progress showed no complications. The children micturated spontaneously and were increasingly free of residual urine after catheter removal. 2. The histological and immunohistochemical examination by means of ASMA and Desmin as smooth muscular antibodies showed evidence of the morphological integration of the transplant in all layers. 3. The histo-pathological findings conform with the clinical, sonographic and urodynamic results. Over an observation period of one year, the increase in size of the starting volume of the urinary bladder can be expected to be a factor of 3–4. Conclusions The application of Surgisis “SIS” permits new, multiple options for bladder augmentation in children. According to the assessments to date the "SIS" transplant seems to be superior to conventional techniques.