ESPU Congress 2018 - Abstract Book

CONGRESS OF THE ESPU

14:24–14:27

S1-12 (PP)

MUCOSECTOMY DISRUPTING ENTERIC NERVOUS

SYSTEM MAY BE CONTRIBUTING TO FLAP CONTRACTION

IN ILEOCYSTOPLASTY WITH SEROMUSCULAR ILEAL FLAP

Tamas CSERNI

, Daniel URBAN

, Daniel HAJNAL

, Gabriella VARGA

Daniel ERCES

and Raimondo CERVELLIONE

1) Royal Manchester Children's University Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) University

of Szeged, Hungary, Institute of Surgical Research, Szeged, HUNGARY - 3) Royal Manchester Children's University

Hospital, Manchester, UNITED KINGDOM

PURPOSE

Bladder augmentation with seromuscular ileal flap is a promising alternative approach for mucus

free bladder augmentation, however the contraction of the flaps remains a major concern. Abnormal

enteric nervous system (ENS) is responsible for failure of relaxation of the intestinal muscle in

motility disorders like Hirschsprung disease, Intestinal Neuronal Dysplasia or Hypoganglionosis. In

mammals submucosal enteric nervous plexus contains nitrergic inhibitory motoneurons responsible

for muscle relaxation. We hypothesised mucosectomy disconnects submucosal nervous plexus

and the myenteric plexus resulting in flap contraction.

MATERIAL AND METHODS

After ethical approval Ileal mucosectomy was performed in 5 anesthetised pigs. In group I. only

the mucosa was scraped off with forceps (sero-musculo-submucosal flap) while in Group II. the

mucosa and submucosa was pealed off in one layer (sero-muscular flap). The width of the flaps

was measured before and after mucosectomy. The ENS was assessed by Neurofilament (NF)

immunohistochemistry in conventional sections, and by Nadph-d enzyme histochemistry in Whole-

mount preparation.

RESULTS

The flaps contracted from the original 100 % width to 81,68 +/- 4,25 % in Group I. and to 72,675 +/-

5,36 in Group II. (p = 0,002). Equal Variance Test showed significant difference between Group I.

and II. (p=0.009). The NF immunohistochemistry revealed the submucosus nervous plexus contain-

ing nitrergic inhibitory neurons was disconnected from the myenteric plexus in Group II.

CONCLUSIONS

Mucosectomy results in significant contraction of the seromuscular flap. This may be explained with

disrupted ENS.