Announcement

Collapse
No announcement yet.

Dr. Wise; Laboratory Grown Bladder

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #16
    Originally posted by Keith View Post
    So what does this mean when they find a repair/cure 4 sci, we still going to have to have catheters/super pubic ways to void? Or will we be able to retrain the bladder & it will learn to expand and be able to hold more? Or is this just way too early to ask this question? Because no one knows how much function or what we will get back in the future.
    Keith,

    Let me explain. I think that the title of the thread and the article gave the misleading impression that they have developed something that could replace the bladder. I posted to indicate that I did not think so. This simply makes a biological tissue that can be used as a substitute bladder wall and surgeons can use this for augmentation procedures.

    People who have had an augmentation of the bladder can no longer contract the bladder and therefore will not be able to micturate (pee) on their own. In theory, augmentation surgery may be reversible but it will probably be difficult or possibly impossible. However, for many people with spinal cord injury, particularly women with tetraplegia, it is the only solution that is available now to improve their quality of life. Regarding Mitrofanoff procedure and augmentation, I hope that I have not given the impression that it is always done in conjunction with augmentation.

    Most tetraplegic women do not have the manual dexterity to catheterize by themselves. They must take some clothes off and recline in order to insert the catheter. They cannot do this without help. For this reason, a suprapubic catheter is often used in people with tetraplegia but is not a particularly good long-term solution for somebody who is active. So, many women opt for a Mitrofanoff procedure which uses the appendix to create a tunnel between the belly button and the bladder, allowing a woman to catheterize without having to take her pants off and reclining.

    However, due to bladder spasticity, the bladder is often contracted and it takes much time and effort to increase bladder capacity. Increasing bladder pressure is also needed to expand the bladder capacity and this might put the kidney at risk. An "augmentation" uses a piece of intestine (enteric) or stomach (gastric) to patch the bladder. Since the "patch" cannot contract, it immediately increases the bladder capacity and reduces the ability of the bladder to contract. This reduces the pressure increases in the bladder associated with bladder spasticity. Such pressure increases pushes urine up the ureters to the kidney and can cause kidney infections and damage.

    Mitrofanoff has been used in many children and people over the last 25 years. If the bladder is flaccid, there is no need for augmentation. However, in people with spastic bladders, augmentation will increase bladder capacity and avoid the risk of high bladder pressures needed to expand bladder capacity. So, increasing numbers of people have gotten a Mitrofanoff plus augmentation. However, recent studies have indicated that there is an increased risk of cancer associated with augmentation with intestine or gastric patch. The cancer apparently occurs in the patch. My review of the literature suggest that the risk of cancer occurring in the patch may be as high as 4.5% over a 10-20 year period. There may be other complications.

    If the new artificially grown bladder walls turn out to be more resistant to cancer, they would be desirable. However, I am not sure that this data is available yet because relatively few patients have received this treatment and I think that studies were done only 5-6 years ago and long-term followup is necessary to determine cancer risk.

    This discussion is actually stimulating some new ideas. If augmentation is being done to increase bladder capacity, there must be other ways of increasing bladder capacity without augmentation. With further thought, I realize that there are indeed some other possible approaches.
    • Botox. This is now being used to reduce bladder contractions. Botox is toxic to the nerve fibers that innervate the bladder. Because the nerves grow back over a period of several months, this is not a permanent solution, it does increase the bladder capacity temporarily, during which it may be possible to maintain the bladder capacity by catheterizing intermittently so that urine will accumulate in the bladder and use of bladder antispasticity drugs such as ditropan.
    • Capsiacin. Several studies have shown that capsaicin (the essence of pepper) and various synthetic drugs that have similar effects, will cause prolonged relaxation of the bladder. This would have a similar effect as Botox and similar methods can be used to maintain the increased bladder capacity.
    • Direct expansion. I have been wondering whether it is possible to put a balloon into the bladder and simply expand the balloon to stretch the bladder wall. This might have to be done several times over a period of weeks but it would allow the expansion of the bladder without damaging the nerve supply to the bladder and without increasing the risk of cancer, as an augmentation seems to do.

    By the way, while the discussion is not about the "cure" for spinal cord injury, it is pertinent to the "cure" of bladder spasticity. It is not trivial because bladder infections were the number one cause of death of people with spinal cord injury. Improved bladder care was the main reason that most people with spinal cord injury today die of heart disease and cancer.

    Wise.
    Last edited by Wise Young; 04-15-2009, 09:02 AM.

    Comment


    • #17
      An "augmentation" uses a piece of intestine (enteric) or stomach (gastric) to patch the bladder. Since the "patch" cannot contract, it immediately increases the bladder capacity and reduces the ability of the bladder to contract. This reduces the pressure increases in the bladder associated with bladder spasticity. Such pressure increases pushes urine up the ureters to the kidney and can cause kidney infections and damage.


      Recent studies have indicated that there is an increased risk of cancer associated with augmentation with intestine or gastric patch. The cancer apparently occurs in the patch. My review of the literature suggest that the risk of cancer occurring in the patch may be as high as 4.5% over a 10-20 year period. There may be other complications.

      So, I agreed that if the new artificially grown bladder walls turn out to be more resistant to cancer, they would be desirable.
      I'm scheduled to have this done using the intestine later this year to reduce pressures and so I can continue cathing and avoid a sphincterotomy.
      I don't want my intestines cut, scares the hell out of me, and I'm uneasy about the cancer risks.
      I really wish this grown bladder technology was an option for me, regretably it seems I will miss out.

      Here's hoping this technology gets offered to people asap!

      Comment


      • #18
        Originally posted by brython2 View Post
        I'm scheduled to have this done using the intestine later this year to reduce pressures and so I can continue cathing and avoid a sphincterotomy.
        I don't want my intestines cut, scares the hell out of me, and I'm uneasy about the cancer risks.
        I really wish this grown bladder technology was an option for me, regretably it seems I will miss out.

        Here's hoping this technology gets offered to people asap!
        Brython2,

        I understand what you are feeling and also agree with your choice. In my opinion, the risk of dying from nephritis in people with uncorrected bladder spasticity is probably greater than 50%, much higher than the 5% risk of getting cancer after augmentation. A sphincterotomy is not easily reversible and requires a full-time condom catheter to keep from leaking. So, the choices are not great.

        The risk can be reduced significantly by having regular cystoscopies to look for any evidence of abnormal growth. I also understand that smoking markedly increases bladder cancer and should be stopped. Finally, you may want to consider getting botox therapy of your bladder to reduce the spasticity. At the present, it is only a conjecture that the new laboratory grown bladder walls will be more resistant to cancer formation. That has yet to be shown.

        Wise.

        Comment


        • #19
          Originally posted by Rollin Rick View Post
          So what happens to all of us Foley catheter users in the future, those of us that can only hold 100-200 CC in our tiny bladders?
          I might miss something here, as usuallol

          But why not to go suprapubic>?
          http://stores.ebay.com/MAKSYM-Variety-Store

          Comment


          • #20
            Originally posted by Max View Post
            I might miss something here, as usuallol

            But why not to go suprapubic>?
            Hey Max,

            I actually do have a suprapubic catheter, I have always called it a Foley. I understand that most people that have the catheter going up not so Mr. Happy is called a Foley catheter, or so called Urethra.

            Basically I was asking the same question that Keith just mentioned.

            Dr. Young, how about clamping off the catheter a couple of times a week to expand the bladder somewhat, but not over do it to a point where you're getting bad A.D.? Would this be feasible for someone with low spasticity/pressures? I actually tried this this morning and was able to hold approximately 300 CC, I didn't think that was bad for having a suprapubic for almost 8 years, what's your opinion?
            A good friend is someone who will come to bail you out of jail. A TRUE friend is the guy sitting next to you behind the same set of bars saying, "boy we sure f*cked up this time huh?"

            Comment


            • #21
              This is another good reason to quit smoking on the other side of things C3 complete quad is one of the few things I do enjoy. You tell me six months or one year from now there will be a repair 4 sci I will never have another cig, a friend of mine had pancreatic cancer, did not smoke for 20 plus years was not drinking neither, really started all over again figured might as well enjoy something while he had time. I have a neurogenic take one pill press X 4 makes a big difference, but still get chronic utis, with a super pubic, that's what's going to kill me. We still need a cure 4 sci but how do you make the bladder expand? Otherwise we could be walking but still have a leg bag.
              keiffer66

              Comment


              • #22
                GROWING BLADDERS: progress?

                Hi all

                wondering whether anyone knows what is happening with the Tengion clinical trial to grow bladders for patients with SCI and use them in augmentations. I had been following this online, and it was at a stage 2 trial.Last year the company went into bankruptcy but was bought out by some staff.

                Does anyone know results and if/when we will know whether it is a viable option. Understand it doesnt restore function but an augmentation using own bladder cells rather than bowl which produces mucus sounds appealing. I'm facing choice of suprapubic or augment & mitro to self cath- but seems shame to not try and find out where this research is at as it started over 10 years ago and the internet has stories of people living with these bladders.

                STAGE 2 RESEARCH
                http://www.cmbt.su/eng/news/news1365.html

                BANKTRUPTCY/ BUY OUT LINK

                http://www.journalnow.com/business/b...f7a43c3ed.html

                Anyone else interested in progress on this?
                "The impossible is just that which hasn't been done yet.Impossible is nothing"

                Comment


                • #23
                  Yeah that's huge!! Like ive just come to head that having an SP cath for over a decade, which I have, is pretty much SOLID case of developing cancer there...n I've been noticing weird things, perhaps <hopefully not> pre-cursors to it..
                  The brute protocol's after make me lean interest to this..
                  I am not your rolling wheels
                  I am the highway
                  I am not your carpet ride
                  I am the sky
                  I am not your blowing wind
                  I am the lightning
                  I am not your autumn moon
                  I am the night, the night..

                  Comment


                  • #24
                    Tengion bankruptcy? Heard they didn’t have a pot to piss in,or bladder to piss from(?)
                    I’m in my lucky 13th year of having a sp tube. Hated it from moment I got it. Now I can just await the big C.

                    Comment

                    Working...
                    X