Urogenital reconstructive Surgery Lotte Kaasgaard Jakobsen 1 Gitte

Urogenital reconstructive Surgery Lotte Kaasgaard Jakobsen 1, Gitte Hvistendahl 1, Karl-Erik Andersson 2, Henning Olsen 1 1 – Dept. of Urology, Aarhus University Hospital 2 – Dept. of Gynecology and Obstetrics, Aarhus University hospital Background: Congenital malformations, such as posterior urethral valves, cause obstruction of the lower urinary tract, resulting in voiding disabilities, renal failure and chronic bladder changes. Despite the infrequency of these malformations they comprise a major challenge in pediatric urology. Managing children with such malformations often require extensive medical treatment, as well as repeated surgical procedures. Treatment causes negative side effects and not always satisfactory results. Aim: Develop an animal model of congenital infravesical obstruction. Utilising this model to further characterise the functional and structural changes that occur in the bladder when obstruction is present. Evaluate and compare the effects of different surgical treatment options. Improving our understanding of the multifacetted pathologies arising due to the malformation. Making way for development of better treatment options for patients with this rare, but serious condition. Materials and methods: Four groups of young male swine will be investigated. Urethral obstruction will be created surgically in groups 2 -4. After 4 weeks, continuous unloading will be performed by vesicostomy in group 3, and intermittent unloading by urethrostomy in group 4. Group 2 will not be unloaded and will serve as continously obstructed controls, while group 1 serve as sham-operated, non-obstructed controls. Urodynamic assessment will be performed during every procedure and samples of urine, blood and bladder tissue will be collected. Biomechanical, histological and immunohistochemical properties of the tissue will be examined. First procedure Second procedure 4 weeks Third procedure 4 weeks Group 1 Sham surgery Final investigation Group 2 Obstruction created Sham surgery Final investigation Group 3 Obstruction created Vesicostomy Final investigation Group 4 Obstruction created Urethrostomy Final investigation