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Vol. 38. Issue 1.
Pages 55-61 (January - February 2014)
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Vol. 38. Issue 1.
Pages 55-61 (January - February 2014)
Skill and talent
Bladder changes after several coverage modalities in the surgically induced model of myelomeningocele in lambs
Cambios en la vejiga después de varias modalidades de cobertura en el modelo de mielomeningocele inducido quirúrgicamente en corderos
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L. Burgosa,
Corresponding author
lauraburgos33@hotmail.com

Corresponding author.
, J.L. Encinasb, M.Á. García-Cabezasc, J.L. Peiród, M. López-Santamaríab, E. Jaureguízara
a Departamento de Urología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
b Departamento de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid, Spain
c Departamento de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain
d Cirugía Pediátrica, Unidad de Cirugía Fetal y Neonatal, Hospital Vall d’Hebrón, Barcelona, Spain
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Table 1. Study groups.
Table 2. Micro and macroscopic appearance of each treatment group.
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Abstract
Objective

To assess the presence of early bladder abnormalities in a prenatally corrected and uncorrected animal model of Myelomeningocele (MMC).

Method

A MMC-like lesion was surgically created in 18 fetal lambs between the 60th and the 80th day of gestation. Eight of them did not undergo fetal repair (group A), three were repaired with an open two-layer closure (group B), three using BioGlue® (group C) and four fetoscopically (group D). At term, bladders were examined macroscopically and histopathological changes were assessed using H–E and Masson Trichrome.

Results

Five animals in group A (5/8, 62%), two in group B (2/3, 66%), one in group C (1/3, 33%) and one in group D (1/4, 25%) survived. Macroscopically bladders in group A were severely dilated and showed thinner walls. Microscopically they showed a thin layer of colagenous tissue (Blue layer. BL) lying immediately subjacent to the urothelium. The muscular layers were thinner. Non compliant pattern with thick wall and low capacity was also found in the non corrected model. Group B and the control showed preservation of muscular layers and absence of BL. Groups C and D presented BL but also preservation of muscular layers.

Conclusion

Bladder changes in a surgically induced model of MMC can be described using histopathological data. Both extremes of bladder changes can be observed in the model. These changes were completely prevented with open fetal surgery and partially with other coverage modalities.

Keywords:
Myelomeningocele
Fetal
Bladder
Histopathology
Sheep
Coverage
Blue layer
Resumen
Objetivo

Determinar las anomalías vesicales precoces en un modelo animal de mielomeningocele (MMC) con y sin corrección quirúrgica intraútero.

Método

Creamos una lesión similar al MMC en 18 fetos de cordero entre los días 60 y 80 de gestación. Ocho de ellos no se repararon prenatalmente (grupo A), 3 se intervinieron mediante cierre abierto en 2 planos (grupo B), 3 se cerraron con pegamento biológico (grupoC) y 4 por fetoscopia (grupo D). Al final de la gestación las vejigas se estudiaron macroscópica e histológicamente usando tinción de hematoxilina-eosina y tricrómico de Masson.

Resultados

Cinco animales del grupo A (5/8, 62%), 2 en el grupo B (2/3, 66%), uno en el grupo C (1/3, 33%) y uno en el grupo D (1/4, 25%) sobrevivieron. Macroscópicamente las vejigas del grupo A estaban muy dilatadas y sus paredes eran muy finas. Microscópicamente mostraban una delgada capa de colágeno (capa azul [CA]) inmediatamente por debajo del urotelio; las capas musculares estaban muy adelgazadas. En el grupo no corregido también encontramos vejigas de baja acomodación, con paredes engrosadas y capacidad disminuida. El grupo B y el control mostraban preservación de las capas musculares y ausencia de CA. Los grupos C y D presentaban CA y preservación de las capas musculares.

Conclusión

Los cambios vesicales en el modelo quirúrgico de MMC en corderos pueden describirse mediante datos histopatológicos. Ambos extremos del espectro pueden darse en dicho modelo. Estos cambios pueden prevenirse por completo mediante cirugía fetal abierta y parcialmente a través de otras formas de cobertura.

Palabras clave:
Mielomeningocele
Fetal
Vejiga
Histopatología
Ovega
Cobertura
Capa azul

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