TECHNIQUE FOR IMPLANTATION OF THE
AVCO BLADDER STIMULATOR
by Adrian Kantrowitz, M.D.

With the atidomen prepared and draped in the usual fashion,

a 15 cm suprapubic midline incision is made in the skin.

The recti are separated in the midline and the peritoneum
retracted gephalad entering the space of Retzius. About
4.0-5.0 cm of the musculature of the bladder's anterior

wall is exposed by blunt dissection. A second skin incision,
4.0 cm in length, on the right side at the level of the
umbilicus,is carried down to the anterior rectus sheath.

A pocket is formed by blunt and sharp dissection immediately
anterior to the anterior rectus sheath. A Kelly elamp is
inserted through the subcutaneous tissues, forming a tunnel
connecting the two incisions.

The Avco Bladder Stimulator is implanted in the pocket, and
the stainless-ste@l electrodes are passed thhough the tunnel
to the first incision. To preserve the stimulator's hermetic
sealing, no sutures are passed through its silicone sheath.
Wound closure is effected by a series of plain catgut

sutures for the subcutaneous tissues and silk sutures for

the skin. The device is thereby firmiay fixed.

By means of a needle at the distal end, each electrode is
implanted in the anterior surface of the bladder. The first
needle is thrust into the detrusor muscle, without entering
the bladder lumen, and drawn out approximately 14 cm from
the entry point, pulling the Silastic-insulated portion into.
the bladder.wall. The needle is then turned around,, passed
back through the bladder wall a second time, to piill the
bared portion of the electrode into the bladder wall. Care
is again taken to avoid entering the bladder lumen and to
bring the needle out near the entry point of the insulated
portion. The bared wire is fixed to the first limb of the
electrode with a single silk suture. Thus Medhanical Fixa-
tion is achieved with the first lino of this mattress-like
suture, and electrical contact, achieved by the second limb,

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Cote
(fe 2
Technique, p.2.

The second electrode is implanted in the same way, approxi-
mately 1.0 cm from the first and paralzel to it. Experience
has shown that with this implantation method the mechanical
stress is distributed over a length of the electrodes,
whereas concentrated atress at any one point predisposes

the wire io breakage at that point.

A small segment of polyethylene film is laid over the electrode

assembly, and secured with 6 or 8 silk sutures, to prevent

spread of the stimulating current to adjacent tissues. A

small drain is placed in the space of Retzius. The recti

are reapproximated with interrupted chromic catgut sutures.

Closure 6& effected by interrupted catgut sutures for the
£kascia and subcutaneous tissues and silk sutures for the skin.

AK/md
3/16/64