Adults with myelomeningocele - what happened urologically after leaving childhood?

ESPU Programme 2009 S39

# P01-4 (PP)

Magdalena Vu MINH ARNELL1, Katarina Seljee SVEDBERG1, Birgitta LINDEHALL1 and Kate ABRAHAMSSON2

1Uroterapeutic unit Rehabilitation centre, Pediatric Urology Section The Queen Silvia Children s Hospital, Gothenburg, SWEDEN,2Urology, Pediatric Urology Section The Queen Silvia Children s Hospital, Gothenburg, SWEDEN

PURPOSE

Due to careful follow-up and intensivetreatment most children and adolescentswith MMC have normal renal function andsocial acceptable continence. The aim ofthe study was to make a survey of thebladder and bowel situation in adulthood.

MATERIAL AND METHODS

There were 152 children and adolescentswith MMC, born before 1980, who had atleast 2 assessments by the urologist at theRehabilitation Centre in Gothenburg. Ofthem, 100 individuals were randomly chosen

and 66 (30 males, 36 females), witha median age of 38 years (range 28-51),accepted to participate in a telephoneinterview.

RESULTS

Upper secondary school was passed by 75%of the individuals, 68% were employed and35% were married or lived with a partner.Surgery of the urinary tract was performedin 35% of the patients and of the intestine in14 %. CIC was done by 70% and enema usedby 14 %. However, during daytime 60% of theparticipants had episodes of urinary leakageand 50% episodes of faecal leakage. Pads

were used in 70% of the patients whileanticholinergic treatment was registered in12%. In 1/3 of the adults there was nourological follow-up at all or in a frequencyof less than once every 5 years. Seventeen %had support by urotherapist, while none hadsupport regarding bowel-emptying regimen.

CONCLUSIONS

In spite of high incidence of incontinenceand despite surgical procedures of theurinary tract in one third of the cases, fewadults with MMC had regular follow-up byurologist and urotherapist.

S03: AUGMENTATION / DIVERSION

# S03-1 (O)

Cornelia TOLG1, Jeff BIERNASKIE1, Lijun CHI1, Karen AITKEN1, Alya AHSAN1, Trupty PANCHAL1, Norm ROSENBLUM1,Freda MILLER1 and Darius BAGLI21Hospital for Sick Children, Developmental and Stem Cell Biology, Toronto, CANADA, 2Hospital for Sick Children, Urology, Toronto,CANADA

PURPOSE

Cystoplasty is used for repair ofcongenital abnormalities such as bladderexstrophy or treatment of acquiredconditions such as neurogenic bladder.Skin derived stem cells (SKPs) are neuralcrest derived progenitors that retain theability to differentiate into a variety ofmesenchymal and neuronal cell types andcould be extremely useful for bladderaugmentation. We therefore tested theability of SKPs to differentiate intobladder smooth muscle cells (BSMcell),a mesenchymal cell type, by exposingthem to microenvironments that stimulateproliferation or differentiation ofBSMcells.

MATERIAL AND METHODS

Rat SKPs were injected into ex vivo organcultures of either mouse embryonic bladdersor adult rat bladders exposed to mechanicalstrain. Alternatively, SKPs were exposed todifferent patterns of mechanical strain invitro. Expression of smooth muscle specificmarkers was analyzed byimmunofluorescence microscopy (SMactin,desmin, SMmyosin) and real time PCR(SMactin, SMmyosin, SM22, calponin,myocardin).

RESULTS

SKPs that were injected into embryonic(E12.5) mouse bladders integrate into thedeveloping muscle and urothelial layer and

express SMactin and desmin. SKPs injectedinto stretch injured adult bladders primarilyintegrate into the urothelium and theinterstitial spaces; few SKPs express BSMcellspecific markers. Exposure of SKPs tosustained or sinusoidal patterns of stretchmodifies expression of BSMcell specificmarkers.

CONCLUSIONS

SKPs can differentiate into BSMcells whenprovided with adequatemicroenvironmental cues such as theembryonic bladder and could potentiallybe used for bladder augmentationsurgery.