We successfully conducted the cystoplasty by regeneration on 2 cases of tuberculous contracted bladder by means of a Novectane-sprayed gelatin sponge bladder which was devised and developed by Tsuji, Orikasa, and other collaborators. Through the follow-up examination we observed that the gelatin sponge broke into small pieces, fell off, and at the same time stuck to the granulation bladder wall. The stuck gelatin sponges might result in inflammation and calculi, bringing disadvantageous factors for regeneration of the bladder. Furthermore, the fragility of the gelatin sponge itself made the delicate process of operation difficult.
In our view, an ideal material for regeneration of the bladder is that which makes easy operation possible, does not absorb or stick to the granulation bladder, and falls off completely from the granulation wall after a certain period following the completion of the bladder.
As shown in Figs. 1, A) and B), we have made artificial bladders with Novectane-sprayed thin papers (Japanese paper or tissue paper). As thin paper is used, any form of a paper bladder can be made by cutting and sticking together according to the operator's intension. A Novectane bladder with a core of thin paper is prepared by repeated spraying Novectane on this thin paper and drying. This artificial bladder is very stout with high elasticity due to the property of Novectane. We carried out the cystoplasty by regeneration to a 29 years old female with this artificial bladder. The details of cystoplasty by regeneration are illustrated in Figs. 3 and 4: The contracted bladder was subjected to a crucial incision, sharp and expansive. A No. 15 porous Nelaton catheter was inserted from the urethra into the bladder and the artificial bladder was sutured with the original incised one with a margin of 1cm using 00 cutgut (Fig. 4). All the procedures were performed outside the peritoneum. The artificial bladder fell off completely in the bladder, following the completion of the granulation bladder as shown in Fig. 5, in about 4 weeks after the cystoplasty. The fallen artificial bladder was extirpated transurethially. It was taken out, as shown in Fig. 1 C), in an utterly unchanged state.
Afterwards, as in Fig. 6, clear discrimination could be made between the original bladder wall and the granulation one inside the bladder. No foreign body that might cause calculi and inflammation was found to stick to the granulation bladder wall. The rapid regeneration of mucous membrane and vessels occurred from the original bladder over this granulation wall. And it was about 6 months until the whole granulation bladder wall was covered up. The progress of this regeneration of mucous membrane is shown in Figs. 7, 8, 9, and 10.
Clinical observations by cystogram are given in Figs. 2, (1), (2), (3), (4), (5), and (6). The capacity of the bladder was 50-60cc and the daily frequency of urination was 45-60 times before the operation. Following the cystoplasty the bladder capacity increased up to 350-400cc, being about 5-7 times as much as the value before the cystoplasty. The frequency of urination reduced to within 10 times daily.
As shown in Fig. 2, (5), the almost normal pattern of cystogram was observed about 4 months after the cystoplasty and residual urine also decreased to less than 10cc in 6 months after the cystoplasty.
Cystometrogram of 8 months after the cystoplasty is shown in Fig. 11. According to this cystometrogram, the first desire to void was at 270cc when the inner pressure was 13mmHg. On the other hand, the urgency was at 350-360cc when the inner pressure was 25-31mmHg. This was improved gradually with the regeneration of mucous membrane and an almost normal state was recovered in 8 months.
The patient was allowed to walk after about 2 weeks and to urinate by herself after about 3-4 weeks. At present, she is healthy and manages normally her household.
Following this