Type of Surgery
Information
Last updated: 02/17/2009
Standard augmentation involves segments of the bowel used to create a pouch or wider wall for the bladder in order to enhance its reservoir capacity. Often this reconstruction surgery is accompanied by procedures that tighten the neck of the bladder,...
as well. Milkulicz performed the first clinical augmentation cystoplasty using abdominal tissue in 1898. Couvelaire, in the 1950s, popularized bladder augmentation for the treatment of the contracted bladder due to tuberculosis. Until the 1970s it was thought that those with bladder dysfunction could be treated with bladder diversion, and that this procedure offered a simple and safe means of emptying the bladder. However, it was soon discovered that pressure from the bladder caused irreparable damage to the kidneys, with 50% of patients exhibiting such deterioration. The new diagnostic assessment of the bladder as well as the need for a new medical intervention for patients with severe bladder dysfunction opened the way for urinary tract reconstruction. Today, many techniques are available, along with new types of grafting substitutions.
The basic procedure involves open abdominal surgery with resection of a 10–20 in (25–30-cm) segment of ileum, cecum (first part of the large intestine), or the ileocecum (the junction of small and large intestines) cut down the middle (detubularized), and shaped into a U-configuration with a pouch at the bottom. This opening or pouch will be the "patch" for the bladder. During surgery, the bladder itself is also opened at the dome and cut at right angles to create a clam-like shape. The open bowel "patch" is then attached to the bladder with sutures or stapling.
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Other Information
Bladder augmentation is a surgical alteration of the urinary bladder. It involves removing strips of tissue from the intestinal tract and adding this to the tissue of the bladder. This has two intended results: increased bladder volume; and a reduced percentage of the bladder involved in contraction, that in turn results in lower internal pressures in the bladder during urination.
Risks of bladder augmentation include incomplete voiding of the bladder post-surgery (resulting in the patient having to undergo intermittent catheterisation or an indwelling catheter), acute intestinal obstruction due to adhesions some years after surgery, and, in extremely rare cases, cancers of the intestinal tissue within the bladder. It must be stressed that this risk is very small, and some specialists[weasel words] still regard the link to cancer as a theoretical one.
Other Information
In 2000, the estimated number of doctor visits and outpatient hospital visits by adults aged 20 or older with “calculus of kidney and ureters” as a listed diagnosis was of 2 million visits with urolithiasis as the primary diagnosis.
From: NKUDIC
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