Figure 7

The bladder transplantation procedure. (a) The vascular pedicles dissected from the uterus with all adjacent vascular plexuses cauterized hanged on a thread. (b) For better visualization of the vascular bundles, the bladder is raised up. (c) Following the propagation of the left and right urinary bladder vessels, we dissected the vascular pedicle iliac bifurcation cutting all vascular branches using cauther and titan clamps (arrows). (d) The right vascular pedicle was clamped, and after the left iliac artery and vein double successive clamping, the urinary bladder was excised "en block" with the trigonal region. The cauterized vessels are marked with arrows. (e) After the femoral artery and vein were exposed, the donors left the vascular urinary bladder pedicle based on the iliac artery, and the vein stump was anastomosed end-to-end interrupted (artery) or continuous (vein) microsurgery technique. (f) Successful bladder transplantation in a groin area after 60 min post-transplantation. The vascular pedicle was patent, and all bladders were well blood supplied. Vascular anastomosis marked with an arrow. UB urinary bladder, U uterus, LUBA left urinary bladder artery, LUBV left urinary bladder vein, RUBA right urinary bladder artery, RUBV right urinary bladder vein, LP (LUBA + LUBV), RP (RUBA + RUBV). LIIA left internal iliac artery, LIIV left internal iliac vein, LFA left femoral artery, LFV left femoral vein.