Ileocecocystoplasty for the management of refractory neurogenic bladder: surgical technique and urodynamic findings.
A total of 21 incontinent adults with a neurogenic bladder who were refractory to conservative management underwent a modified technique of ileocecocystoplasty. Followup ranged from 1 to 6 years (mean 3.1 years). To ensure a wide anastomosis the augmentation was accomplished by suturing a detubularized ileocecal patch to a large posterior based bladder flap anchored to the psoas muscles. Postoperatively 20 of 21 patients were continent. The remaining woman was cured after surgical correction of sphincteric incontinence. Mean bladder capacity increased from 185 +/- 17 to 595 +/- 43 ml. (standard error). Mean maximum detrusor pressure decreased from 53 +/- 6.3 to 16 +/- 2.3 cm. water (p less than 0.0001). Followup revealed a persistently large capacity, low pressure reservoir in all patients. No patient required anticholinergic medication. None experienced acid-base imbalance, tumors in the augmented bladder or upper tract deterioration. We conclude that this technique of ileocecocystoplasty is suitable for the management of patients with a refractory neurogenic bladder.
Department of Urology, Columbia-Presbyterian Medical Center, New York.
R
R
Luangkhot
B C
BC
Peng
J G
JG
Blaivas
D000328:Adult; D000368:Aged; D002432:Cecum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics