Therapeutic Approaches, to Restore or Augment Detrusor Contractility “Bladder Wrap Procedures”

When a urinary bladder is acontractile, a comprehensive approach to the problem is to try and bring new functional muscle to the bladder wall. To establish this a skeletal muscle can be transposed around the bladder wall. Several procedures have been attempted in the last three decades. In all these cases a major challenge is to achieve muscle functionality in order to allow bladder emptying at an appropriate moment. Therefore, the muscle has to be innervated and should be at a length adequate to allow contraction. The muscle should contract during voiding and not during other activities such as physical exercise. In this chapter we discuss the progress to date in developing bladder wrap surgery.