Laparoscopic Augmentation Ileocystoplasty: Results and Outcome

Case report: The theory of post-ileocystoplasty spherical configuration in patients with low-capacity bladder

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Detubularization form offers greater volume and lower pressure in the reservoir to augment the bladder.

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Patients with low-capacity bladder who have poor compliance with ureteral involvement have poor renal function.

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Low compliance bladder will cause numerous symptom such which will lead to insufficient bladder emptying.

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Bladder augmentation is a management option for neurogenic and non-neurogenic bladder dysfunction when conservative management, medical pharmacological therapy and minimally invasive management have not yielded satisfactory results.

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The aim of doing bladder augmentation is to create a reservoir with adequate functional capacity and low bladder filling pressure so that low intravesical pressure will not interfere with the flow of urine from the bladder to the urethra.

Introduction

Bladder augmentation can be performed by detubularization of the small or large intestine. A large capacity bladder is necessary to avoid frequent urination; thus, the ileal sac must be able to store the maximum volume of urine with relatively low pressure and the shortest length of the intestine. The acceptable pressure capacity should always be under ureteric pressure to avoid back pressure and kidney damage. Large capacity at low pressure is referred to as good compliance. Desirable preparations for augmentation, which is the use of the shortest length of the intestine, reduce the chance of diarrhea and vitamin deficiency and retain the intestines which may be required for augmentation.

Aim

Clinical and urodynamic evaluation of the recent postoperative condition of the patient who underwent ileocystoplasty, confirmed by the theory of detubularization (spherical) configuration.

Case presentation

Patient with complaints of frequent urination and small amount of urine. Ultrasound examination showed low volume bladder capacity and bilateral hydronephrosis and hydroureter. From cystography and VCUG examination, low capacity bladder, grade 1 VUR on the right side, grade 4 VUR on the left side accompanied by bilateral hydronephrosis and hydroureter. The patient has a history of right nephrectomy in 2014 for pyonephrosis due to kidney stones. The patient was then subjected to bladder augmentation using a segment of the ileum (ileocystoplasty) in 2015. In the postoperative evaluation, clinical symptoms, radiological and uroflowmetric examinations were evaluated.

Conclusion

The detubularization form offers greater volume and lower pressure in the reservoir to augment the bladder.

Robot-assisted laparoscopic augmentation ileocystoplasty and excision of an intraperitoneal mass: a case report

Objective

This case is reported to introduce an advanced surgical technique and share our experience with surgeons.

Methods

A 53-year-old man was admitted to the Department of Urology of The Second Xiangya Hospital with complaints of frequent urination and dysuria in June 2018. He had been diagnosed with genitourinary tuberculosis and left renal dysfunction at another hospital and had undergone left nephrectomy 6 months previously. At our institution, intravenous urography showed a normally functioning right solitary kidney. Computed tomography indicated a high-density mass in the abdominal cavity. At the patient’s request, robot-assisted laparoscopic augmentation ileocystoplasty and excision of the intraperitoneal mass was performed.

Results

The surgery was performed using a completely intracorporeal technique. The procedure was completed in 240 minutes, and the patient was discharged on postoperative day 11. At the 2-month follow-up, ultrasound examination showed that the maximal bladder capacity had increased to 1000 mL. Intravenous urography revealed no urine leakage, and filling of the bladder was satisfactory.

Conclusions

With the development of robot-assisted surgery, robotic surgery can be successfully used for less frequently performed operations.

Surgical management of the neurogenic bladder after spinal cord injury

PURPOSE

This work represents the efforts of the SIU-ICUD workgroup on this topic and comprehensive literature search of English language manuscripts regarding urologic surgery in spinal cord injury using key words of urologic surgery and spinal cord injury. Articles were compiled, and recommendations in the chapter are based on group discussion and intensive communication. The purpose is to review what has been published during the last decades on urological surgery for neurogenic bladder after spinal cord injury.

METHODS

Surgical techniques applied in spinal cord injured patients for neurogenic bladder dysfunction have been reviewed and the published material evaluated.

RESULTS

There are several techniques that can be used to treat neurogenic dysfunctions and symptoms in refractory cases where conservative treatment failed. The number of publications is small as are the number of patients with spinal cord injury in which they have been performed. The choice of techniques proposed to the patients depends on the exact functional pathology in bladder, bladder neck and urethral sphincter. The final informed choice will be made by the patient.

CONCLUSION

There are surgical urological techniques available to treat neurologic dysfunctions in spinal cord injured patients.

Current trends in minimally invasive reconstructive urology

This paper is a systematic review of the current literature in minimally invasive reconstructive urological surgery. It focuses on the commonest reconstructive procedures in both the upper and lower urinary tracts including laparoscopic and robotic pyeloplasty for ureteropelvic junction obstruction, laparoscopic and robotic bladder diverticulectomy, laparoscopic and robotic partial cystectomy with urinary diversion, laparoscopic and robotic cystoplasty, repair of colovesical fistula, and, in urogynaecology, repair of vesicovaginal fistula. To evaluate the development, current status, feasibility, and safety of minimally invasive surgery (MIS) in reconstructive urology the literature on the topic was collated and reviewed.

Robotic enterocystoplasty: technique and early outcomes

OBJECTIVE

Enterocystoplasty is an established treatment for patients with refractory neurogenic bladder symptoms. We assessed the feasibility, safety, and efficacy of a robot-assisted enterocystoplasty in this population.

MATERIALS AND METHODS

Five neurogenic bladder patients, median age of 43.8 years, underwent the procedure. Using a five-port technique, intraperitoneal robotic enterocystoplasty was performed through the following steps: (1) creation of a U-shaped full-thickness detrusor cystotomy, (2) intracorporeal harvesting of 30 cm of ileum, (3) intracorporeal construction of a detubularized ileal patch, and (4) anastomosis of the ileal patch to the cystotomy. An extracorporeal side-to-side bowel anastomosis re-established bowel continuity. After surgery, urinary continence, bladder capacity, upper tract protection, and complications were assessed.

RESULTS

Mean operative time was 6.4 hours, estimated blood loss was 180 mL, and length of stay was 7 days. Postoperatively, all patients had a functioning enterocystoplasty, urethral continence, and normal upper tract imaging. One patient was rehospitalized for an ileus/urinoma, which resolved with conservative treatment.

CONCLUSIONS

Robot-assisted enterocystoplasty can be effectively and safely performed with minimal morbidity.