Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.

译文

脊髓损伤 (SCI) 至腰s水平会导致膀胱反射亢进和逼尿肌括约肌协同失调 (DSD),并伴有膀胱肥大。我们假设使用膀胱脱细胞基质移植物 (BAMG) 进行膀胱增强可以改善SCI介导的神经源性膀胱的功能。在雌性大鼠 (n = 35) 中,脊髓损伤是由胸下部的脊髓横断引起的。旋转后八周,在肥厚性膀胱半晶体切除术后使用BAMG进行膀胱增强。在旋转后8周进行膀胱造影,并在增强后8周再次进行膀胱造影。测量了几个尿动力学参数,并对移植的膀胱进行了组织学评估。旋转后8周,有31只大鼠存活。22 (71%) 只大鼠出现了反射过度膀胱,而9 (29%) 只大鼠在膀胱增大之前出现了活动不足的膀胱。26只大鼠在扩增后存活到8周。尿动力学参数显示增强后,反射过度和活动不足的膀胱的某些膀胱功能均得到改善。此外,反射过度膀胱的膀胱顺应性增加,而活动不良膀胱的膀胱顺应性降低。膀胱增强降低了高容量大鼠的膀胱容量,而在低容量大鼠中增加了膀胱容量。组织学评估显示,增强后8周,SCI诱导的神经源性膀胱中BAMG完全再生。这是第一份报告,表明使用BAMG增强可以改善SCI诱导的神经源性膀胱的排尿功能。排尿功能的改善伴随着BAMG的组织学再生。

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