Porcine Bladder Augmentation Using Medical Grade Titanium Foil: Initial Experience "Presentation" - Aymon Ali
April 28, 2025
Aymon Ali presents research using 99.9% pure titanium foil for bladder augmentation as an alternative to traditional enterocystoplasty. This approach could represent a significant advancement in addressing poorly compliant, low-capacity bladders while avoiding the metabolic and surgical complications associated with traditional bowel segment techniques.
Biography:
Aymon Ali, MD, Department of Urology, University of California, Irvine, Irvine, CA
Biography:
Aymon Ali, MD, Department of Urology, University of California, Irvine, Irvine, CA
Read the Full Video Transcript
Aymon Ali: Dear viewers, my name is Aymon Ali. I'm one of the endourology fellows here at the University of California, Irvine. Today, I will be talking about my project, "Porcine Bladder Augmentation Using Medical-Grade Titanium Foil: Initial Experience." Augmentation enterocystoplasty is a reconstructive procedure employed in poorly compliant, low-capacity bladders for the prevention of upper tract deterioration.
The procedure has largely remained unchanged for the past 100 or so years and utilizes bowel segments. This in turn causes several downstream metabolic and surgical adverse effects. To date, no acellular or nonbiologic materials have been utilized to augment the bladder. We describe the first nonbiologic alternative to enterocystoplasty by placement of a staple titanium foil augment into the porcine bladder.
To describe the procedure, the bladder of a 40-kilogram, 10-month-old female Yucatan pig was mobilized via an inferior umbilical midline incision. Following this, a six-centimeter anterior midline cystotomy was made. An equilateral, triangular-shaped piece of 99.9% pure titanium foil of a thickness of 0.00157 inches was stapled into the bladder using four reloads of an Endo GIA 45-millimeter TriStapler.
Following closure, a retrograde leak test and a flexible cystoscopy were performed, followed by a cystogram to assess for urine extravasation. Two 10 French Cope loop urethral catheters were placed in the bladder for drainage. A follow-up cystogram, cystoscopy, and bloodwork was conducted at three weeks when the Cope loop catheters were removed and subsequently at six weeks.
During our follow-ups, no loss of bladder capacity was seen on retrograde filling the bladder to 40 centimeters of water pressure. No urinary extravasation was noted on cystogram. Serum creatinine was within normal limits at 0.6 milligrams per deciliter preoperatively and preserved throughout the follow-up period, with the latest value at 0.8 milligrams per deciliter. No early or delayed postoperative complications were noted. No encrustation of the titanium augment was noted at six weeks.
In conclusion, in our initial experience, a sutureless staple titanium foil augment of the bladder was well tolerated in the short term. Our future directions include completion of six titanium augmentation procedures using our porcine model. Each animal will be followed up for a one-year period to ensure treatment durability. Thank you.
Aymon Ali: Dear viewers, my name is Aymon Ali. I'm one of the endourology fellows here at the University of California, Irvine. Today, I will be talking about my project, "Porcine Bladder Augmentation Using Medical-Grade Titanium Foil: Initial Experience." Augmentation enterocystoplasty is a reconstructive procedure employed in poorly compliant, low-capacity bladders for the prevention of upper tract deterioration.
The procedure has largely remained unchanged for the past 100 or so years and utilizes bowel segments. This in turn causes several downstream metabolic and surgical adverse effects. To date, no acellular or nonbiologic materials have been utilized to augment the bladder. We describe the first nonbiologic alternative to enterocystoplasty by placement of a staple titanium foil augment into the porcine bladder.
To describe the procedure, the bladder of a 40-kilogram, 10-month-old female Yucatan pig was mobilized via an inferior umbilical midline incision. Following this, a six-centimeter anterior midline cystotomy was made. An equilateral, triangular-shaped piece of 99.9% pure titanium foil of a thickness of 0.00157 inches was stapled into the bladder using four reloads of an Endo GIA 45-millimeter TriStapler.
Following closure, a retrograde leak test and a flexible cystoscopy were performed, followed by a cystogram to assess for urine extravasation. Two 10 French Cope loop urethral catheters were placed in the bladder for drainage. A follow-up cystogram, cystoscopy, and bloodwork was conducted at three weeks when the Cope loop catheters were removed and subsequently at six weeks.
During our follow-ups, no loss of bladder capacity was seen on retrograde filling the bladder to 40 centimeters of water pressure. No urinary extravasation was noted on cystogram. Serum creatinine was within normal limits at 0.6 milligrams per deciliter preoperatively and preserved throughout the follow-up period, with the latest value at 0.8 milligrams per deciliter. No early or delayed postoperative complications were noted. No encrustation of the titanium augment was noted at six weeks.
In conclusion, in our initial experience, a sutureless staple titanium foil augment of the bladder was well tolerated in the short term. Our future directions include completion of six titanium augmentation procedures using our porcine model. Each animal will be followed up for a one-year period to ensure treatment durability. Thank you.