Chemically induced intestinal de-epithelialization using silver nitrate for bladder augmentation.
The use of bowel segments for bladder augmentation has been associated with metabolic complications, infections, stones, and cancer at the vesicoenteric anastomosis. The establishment of a transitional epithelium over the de-epithelialized surface of a segment of intestine might alleviate these complications. In this study, chemical de-epithelialization and urothelial re-epithelialization were attempted using silver nitrate (AgNO3) solutions at different concentrations. Augmentation cystoplasty was performed in 55 female Swiss-Albino rats using a 1.5-cm detubularized segment of sigmoid. Forty-one rats survived and were killed 12 weeks postoperatively. There were four groups, including one group of eight rats that underwent augmentation alone (group 1, control), while the other three groups were treated with 1 g/100 ml (11 rats), 5 g/100 ml (10 rats), and 10 g/100 ml (12 rats) AgNO3 solutions, respectively, before augmentation. Histopathological analysis demonstrated almost complete de-epithelialization and urothelialization of the sigmoid segment treated with 10 g/100 ml AgNO3 solution, which did not occur in the other groups. Postoperative bladder capacities were increased in all groups. There was no obvious histological difference in the level of collagen deposition and/or fibrosis in the augmented tissues in any of the experimental groups. We conclude that 10 g/100 ml AgNO3 solution can be successfully used for chemical de-epithelialization and urothelial re-epithelialization of augmented intestinal segments, and are worthy of further investigation.