Online Issues

e-Journal Vol 48(3)E1

Refinement in the Management of the Denervated Canine Urinary Bladder Using an Abdominal Vesicostomy

Alexis Agelan, Alan S. Braverman, Gregory E. Dean, and Michael R. Ruggieri Sr.

Alexis Agelan, DVM, is Assistant University Veterinarian in the Central Animal Facility and Alan S. Braverman, PhD, is Research Assistant Professor in the Department of Urology, both at Temple University in Philadelphia, Pennsylvania; Gregory E. Dean, MD, is Associate Professor at Temple University Children's Medical Center in Philadelphia; and Michael R. Ruggieri Sr., PhD, is Research Associate Professor and Director of Urologic Research in the Departments of Urology, Pharmacology, and Computer & Electrical Engineering at Temple University, as well as Research Scientist at the Philadelphia Shriners Hospital.

Abstract

Treatment of the neurogenic bladder in canine models of spinal cord injury presents challenges in ensuring bladder drainage. While vesicostomy is routine for humans, the procedure is not common in canines. Our study of bladder reinnervation involved transection of the nerve roots that mediate bladder contraction in 34 canines. An abdominal vesicostomy was created by fixing the everted mucosa to the skin incision. After euthanasia, we assessed the contractility of in vitro bladder muscle strips in response to muscarinic receptor stimulation. There were a total of 11 complications in 9 of the 34 animals. In two animals, the vesicostomy narrowed such that it could not be catheterized and in two other animals the vesicostomy closed to between 5 and 10 mm diameter. Another animal removed the stitches prior to complete healing, requiring further surgical procedures. In five animals, partial prolapse of the bladder through the vesicostomy required surgical repair, and in one animal the bladder became infected and required antibiotic treatment. In the few animals in which irritation resulted from the constant contact of urine with the skin, daily topical application of petrolatum ointment alleviated this symptom. Gross inspection of the bladder at euthanasia and in vitro contractility of bladder muscle strips from these animals revealed no evidence of changes associated with bladder hypertrophy. This study demonstrated that permanent cutaneous vesicostomy is an optimal refinement method for management of the neurogenic bladder in canines. The procedure avoids the distress as well as potential bladder hypertrophy induced by multiple daily interventions to empty the bladder by either catheterization or manual compression.

Key Words: bladder; cystostomy; hypertrophy; spinal cord injury; vesicostomy