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Abstract Purpose To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures. Patients and methods From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared. Results The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC. Conclusion IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.

Purpose: To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures. Patients and methods: From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared. Results: The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC. Conclusion: IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed. [ABSTRACT FROM AUTHOR]

Introduction. We present the first case of pediatric ileocystoplasty using a purely robotic approach in Spain. Case report. 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladder augmentation with ileum patch was decided upon. Surgery was carried out using a purely robotic approach with 4 robotic and 2 accessory ports. Surgery duration was 380 minutes in total, without intraoperative complications. He was discharged 2 weeks after cystographic control. During 32-months follow-up, he has remained continent. Discussion. The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgical techniques. Given the little availability of the robot and the low pediatric volume, its standardization is a challenge. Our accumulated experience is consistent with the current literature and shows promising surgical and esthetic results. We hope this case report will contribute to the divulgation and progressive introduction of robotic surgery in our daily lives. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess functional outcomes and classify postoperative complications of augmentation cystoplasty by the Clavien-Dindo classification system. MethodsA total of 197 adult patients undergoing augmentation cystoplasty between January 2016 and December 2020 at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), were included in the study after obtaining approval from the ethics review committee. Patients’ records were reviewed for assessment of complications up to 3 months of follow-up. Functional outcomes were assessed by comparing preoperative video urodynamics study (VUDS) findings with follow-up VUDS findings at 1 year. IBM SPSS v23 was used to record and analyze all the complications, treatments, and pre- and postoperative VUDS data. ResultsOf the 197 patients included in this study, 127 (64.5%) were male and 70 (35.5%) were female. The mean age of the patients was 38.4 ± 9.92 years. Eighty-seven patients (44.2%) remained complication-free, 64 patients (32.5%) had grade I-II complications, 44 patients (22.3%) had grade III and IV complications, and only 2 patients (1%) had grade V complications. Stomal stenosis was the most frequent complication, occurring in 14.7% of patients, followed by renal function deterioration and high-grade fever, each noted in 13.7% of patients. Mean preoperative bladder capacity was 144.3 ± 63.09 mL, mean preoperative filling pressure was 43.34 ± 26.92 cm3 H2O, while mean postoperative bladder capacity was 460.83 ± 70.69 mL and mean postoperative filling pressure was 7.47 ± 5.79 cm3 H2O. ConclusionAugmentation cystoplasty can increase bladder capacity and improve bladder function. Because of the potential for complications, it is essential to carefully choose patients for surgery and provide proper preoperative counseling. Additionally, it is crucial to give proactive postoperative care.

Introduction: Bladder augmentation with catheterizable channel creation is indicated for patients with neurogenic bladder (poorly complaint/high pressure) to preserve kidney function and provide long-term social continence when conservative medical management has failed. An open surgical approach is currently the gold standard. Methods: A 10-year-old-male with a history of neurogenic bladder due to sacral agenesis and caudal regression syndrome (wheelchair bound), solitary left kidney with worsening vesicoureteral reflux (grade 3), and continued daytime and nighttime incontinence underwent an open bladder augmentation ileocystoplasty, with creation of an appendicovesicostomy catheterizable channel, and bladder neck reconstruction. Results: Total operative time was 230 min. EBL was less than 50 cc. Patient was discharged on post-operative day 9. At the 6 month post-operative visit, patient is selfcatheterizing the APV channel every 2-3 h with daytime outputs of 300 mL-500 mL and nighttime output between 200 mL-300 mL. Renal ultrasound shows improved grade 3 hydronephrosis, with improved renal pelvis dilation and more robust appearing renal parenchyma. Conclusion: This video demonstrates the steps of an open bladder augmentation ileocystoplasty, with creation of an appendicovesicostomy catheterizable channel, and bladder neck reconstruction.

Introduction: Neurogenic high-pressure bladders may lead to incontinence and upper tract deterioration. Bladder augmentation with creation of a catheterizable channel helps protect the upper tracts and provide patients with a mechanism for social continence. RALIMA offers patients the potential benefits of minimally invasive surgery during major genitourinary reconstruction. We present modifications to our previously described technique to reduce surgical time and for ease of adoption of RALIMA. Patient and Surgical Procedure: An 11-year-old female with a poorly compliant, high pressure, small capacity (73 cc) neurogenic bladder, with detrusor leak point pressure of 8 cm of water, failed conservative measure and subsequently underwent RALIMA, bladder neck reconstruction, and ACE channel creation with cecal flap. Results: Total operative time was 615 minutes, EBL 50 cc, and patient was discharged home on postoperative day 6. Several modifications to our initial technique were utilized to improve operative efficiency, including 1) use of the robotic fourth arm to assist with retraction; 2) relocation of the camera port above the umbilicus to assist with visualization; 3) use of percutaneous stay sutures placed in the ileum to allow for isolation and facilitate bowel-bowel anastomosis; 4) performing the posterior wall bowel anastomosis prior to anterior; 5) utilizing the harmonic scalpel to detubularize ileum, take down bowel mesentery, and perform the cystostomy; and 6) utilizing barbed suture to perform the bowel-bladder anastomosis. Conclusion: The video demonstrates RALIMA with bladder neck reconstruction and ACE channel creation for a high-pressure, refractory neurogenic bladder.

Background: The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. Methods: Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999–2019). Short- and long-term outcomes and complications following augmentation cystoplasty were defined. Results: Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy-epispadias complex (30%) and posterior urethral valves (23%). The most common tissue-type utilized was ileal (58%) and ureteric (30%). Peri-operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end-of-study detrusor pressure improved significantly following bladder augmentation (38–17 cmH2O, P < 0.001). Bladder capacity improved significantly (67–89%, P = 0.041). The median followup was 4.5 years (interquartile range: 1.9–10 years). Bladder urolithiasis affected 13 (18%) patients, and symptomatic urinary tract infections 36 (51%) patients. Formation of a continent catheterisable channel contributed a number of complications relating predominantly to stenosis (50%). Repeat augmentation cystoplasty was necessary in three (4%) cases. Conclusion: Augmentation cystoplasty is a surgical intervention that improves bladder metrics. Given the potential complications, careful patient selection and appropriate pre-operative counselling are essential. Furthermore, pro-active post-operative management and transitional care are vital in the surgical care of children following augmentation cystoplasty. [ABSTRACT FROM AUTHOR]

Introduction The aim of this article was to report the long-term results of increased ileocystoplasty in 58 patients with spinal cord injury (SCI) with an impact on overall renal function and quality of life. In a representative number of patients, where we followed individual subjects for more than 20 years, we wanted to determine their quality of life and preservation of renal function after surgery. Material and methods After unsuccessful conservative therapy of urinary incontinence, increased ileocystoplasty was performed. In addition to biochemical analysis, intravenous urography (IVU) was performed preoperatively (urography and/or ultrasound assessment of the upper urinary tract) and urodynamic tests were performed in all patients preoperatively. Results After a follow-up of patients within the group (>20 years), 2 patients reported being incontinent. The median elapsed time of action was 20 (13-24) years. Vesical capacity increased in all cases postoperatively when the median vesical capacity was 420.0 (387.5-460.0) ml (p <0.001). Long-term complications included use of bladder chambers, kidney stones and urosepsis. Creatinine clearance confirmed satisfactory renal function after the elapsed time period from surgery. Conclusions The results confirmed that augmentation ileocystoplasty had excellent long-term outcomes in the definitive therapy of refractory neurogenic detrusor overactivity in patients with SCI. [ABSTRACT FROM AUTHOR]

To draw attention to the disregarded malignancy risk after ileocystoplasty, we present two cases of adenocarcinoma. The first case was metastatic at initial diagnosis. Despite chemotherapy, the condition progressed and the patient died at the 9th month. The second patient has received cystectomy followed by chemotherapy and radiotherapy. Although the second patient was an immunosuppressed renal transplant, she was disease-free at the 27th month. As the malignancy risk after bladder augmentation is a proven fact, until the discovery of a proper diagnostic method, we recommend doing routine annual cystoscopic biopsy starting after the 10th year of ileocystoplasty.

Even in the present times, there remains a role for augmentation cystoplasty, although its use has become less common due to other less invasive procedures such as intravesical injection of botulinum toxin A and neuromodulation. Ileocystoplasty is the most commonly performed bladder augmentation procedure because of the reconstructive urologist's familiarity with ileum and the ileum's ability to easily reach to the pelvis.

We describe a rare instance of enormous, calcified stone development in an enlarged urinary bladder. The patient was a 24-year-old female suffering from the development of vesical calculus as a result of complicated bladder augmentation. She had a small bladder capacity and had undergone augmentation ileocystoplasty in childhood. The abdomen was examined using X-ray and computerized tomography, which revealed a significantly huge urinary bladder stone. An open cystolithotomy was performed and a giant vesicle calculus was extracted along with another small stone. Although stone development is a typical side effect following augmented bladder, it may be avoided with frequent bladder irrigation and attentive aftercare., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Aljarbou et al.)

Objectives: Third line treatment of urge urinary incontinence (UUI) and/or reduced bladder capacity is bladder augmentation. The aim of this study was to investigate whether clam enterocystoplasty (CECP) was an efficient treatment for patients who were refractory to conservative treatments of UUI and small functional bladder capacity and secondly if there was a difference in outcome in patients with neurogenic and non-neurogenic bladders. Methods: We evaluated 118 patients retrospectively treated in the period 2006–2018 at a single university hospital. Data were collected retrospectively. Patient groups were compared with Wilcoxon signed-rank test and Fisher's exact test. Results: Overall, 76% became continent with 92% using clean intermittent self-catherization (CISC) of patients with neurogenic bladder, 82% became continent and 100% were using CISC, whereas of patients with non-neurogenic bladder 64% became continence and 77% were using CISC. The median overall improvement of capacity was 296.5 mL (IQR: 142–440), 310 mL (186–467) in the neurogenic group and 214 mL (IQR: 126.8–361.5) in non-neurogenic (p = 0.01). Conclusion: CECP is an efficient treatment in UUI and reduced bladder capacity. Difference in outcome was seen with neurogenic patients having a bigger functional capacity and a higher rate of continence compared to the non-neurogenic. [ABSTRACT FROM AUTHOR]

Bladder augmentation is a demanding surgical procedure and exclusively offered for selected children and has only a small spectrum of indications. Paediatric bladder voiding dysfunction occurs either on a basis of neurological dysfunction caused by congenital neural tube defects or on a basis of rare congenital anatomic malformations. Neurogenic bladder dysfunction often responds well to a combination of specific drugs and/or intermittent self-catheterization. However, selected patients with spinal dysraphism and children with congenital malformations like bladder exstrophy and resulting small bladder capacity might require bladder augmentation. Ileocystoplasty is the preferred method of bladder augmentation to date. Because of the substantial long-and short-term morbidity of augmentation cystoplasty, recent studies have tried to incorporate new techniques and technologies, such as the use of biomaterials to overcome or reduce the adverse effects. In this regard, homografts and allografts have been implemented in bladder augmentation with varying results, but recent studies have shown promising data in terms of proliferation of urothelium and muscle cells by using biological silk grafts. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the new technique of Spiral-cap ileocystoplasty for bladder augmentation and simultaneous ureteric reimplant. Materials and Methods: Seven patients with small capacity bladder and simultaneous lower ureteric involvement operated in single tertiary care institute over the last 5 years were included in this study. Spiral-cap ileocystoplasty was used in all the patients for bladder augmentation. Proximal part of the same ileal loop was used in isoperistaltic manner for ureteric reimplantation. Distal end of this ileal loop was intussuscepted into the pouch to decrease the incidence of reflux. Detubularized distal portion of the loop was reconfigured in spiral manner to augment the native bladder. Patients were analyzed for upper tract changes, serum creatinine, bladder capacity, and requirement of clean intermittent self-catheterization in follow-up over 5 years. Results: There was no evidence of any urinary or bowel leak in the postoperative period. Recovery was equivalent with those treated with other methods of bladder augmentation. Follow-up ultrasonography showed good capacity bladder. Upper tracts were well preserved in follow-up. Urinary bladder and lower ureter pathologies were addressed simultaneously. Conclusion: Spiral-cap ileocystoplasty is a useful technique in patients who require simultaneous bladder augmentation and ureteric reimplant.

Some of the patients with genitourinary tuberculosis (GUTB) present to the urologist with small contracted bladders or with significant renal damage. [1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine.

Objectives: Evaluation of the feasibility, morbidity, learning curve, and functional results of robotic supratrigonal cystectomy with augmentation ileocystoplasty (RSCAI). Materials and Methods: RSCAI was performed in 19 patients between 2012 and 2016. Thirteen patients (66.4%) presented refractory detrusor overactivity or impaired compliance and 6 patients (31.6%) had painful bladder syndrome. A combined robot-assisted laparoscopy and mini-laparotomy approach was performed. Early (<30 days) and late (>30 days) complications were reported according to the Clavien-Dindo classification. Functional results were analyzed according to the surgical indication. Results: Mean total operating time was 288.7 ± 92.1 minutes. Mean intraoperative blood loss was 147.4 ± 144.8 mL. Mean length of hospital stay in the surgical ward was 9.4 ± 3.7 days. Mean duration of bladder drainage was 23.3 ± 4.1 days. For surgeons who regularly performed robot-assisted laparoscopy, the learning curve of this technique, as assessed by the operating time, required almost five operations. No major (Clavien-Dindo >2) early (0%) or late (0%) postoperative complication was observed. Early minor complications were observed in 47.4% of cases, usually consisting of pyelonephritis (21.1%). Late minor complications (10.5%) were Clavien-Dindo grade I. Mean follow-up was 13.6 ± 10.1 months. The majority of patients (94.7%) obtained functional improvement of their disease in terms of pain, functional bladder capacity, or bladder compliance. Conclusion: Our RSCAI technique is a reliable technique with no early or late major postoperative complications reported in this series. This technique allows patients to be operated by minimally invasive surgery with very satisfactory long-term functional results. [ABSTRACT FROM AUTHOR]

Even in the present times, there remains a role for augmentation cystoplasty, although its use has become less common due to other less invasive procedures such as intravesical injection of botulinum toxin A and neuromodulation. Ileocystoplasty is the most commonly performed bladder augmentation procedure because of the reconstructive urologist's familiarity with ileum and the ileum's ability to easily reach to the pelvis. [ABSTRACT FROM AUTHOR]

To draw attention to the disregarded malignancy risk after ileocystoplasty, we present two cases of adenocarcinoma. The first case was metastatic at initial diagnosis. Despite chemotherapy, the condition progressed and the patient died at the 9th month. The second patient has received cystectomy followed by chemotherapy and radiotherapy. Although the second patient was an immunosuppressed renal transplant, she was disease-free at the 27th month. As the malignancy risk after bladder augmentation is a proven fact, until the discovery of a proper diagnostic method, we recommend doing routine annual cystoscopic biopsy starting after the 10th year of ileocystoplasty. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the outcome of innervation preserving sphincteroplasty along with anatomical bladder neck reconstruction (IPS-ABNR) compared to classic Young-Dees-Leadbetter (YDL) bladder neck reconstruction in exstrophy with insufficient bladder capacity requiring detubularized-ileocystoplasty. Materials and Methods: Sixteen male patients of exstrophy bladder who required ileocystoplasty from 2004 to 2010 were randomized into group A (n = 7) and group B (n = 9). After detubularized-ileocystoplasty with Mitrofanoff stoma and ureteric reimplantation in all, group A received YDL bladder neck repair while group B received IPS-ABNR repair through a midline scrotoperineal approach. Outcome measurement included operative and postoperative problems, continence, and upper tract status. Results: In group A, two had incompetent bladder neck with gross incontinence, while four had a dry interval of more than 3 h without the ability of voiding per urethra. In group B, seven patients had dry interval of more than 3 h with an ability of urethral voiding and midstream holding in five. Conclusions: Exstrophy patients requiring augmentation cystoplasty and repaired with IPS-ABNR can achieve dynamic bladder outlet resistance with adequate leak point pressure and ability to void voluntarily with midstream holding capability. The children had the satisfaction of voiding per urethra with ability to stop in midstream similar to that in normal children.

The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction.

Genitourinary tuberculosis (GUTB) occurs in 15-20% cases of pulmonary tuberculosis with a prevalence of 400 per 100,000 population. Reconstructive surgery for GUTB is required for cases with grossly distorted and dysfunctional anatomy that are unlikely to regress with chemotherapy alone. In the recent past, there has been a tremendous increase in the variety of reconstructive procedures for the urinary bladder, used in the management of GUTB. Augmentation cystoplasty includes the goals of increasing bladder capacity, while retaining as much of bladder as possible. Various bowel segments (from the stomach to the sigmoid colon) have been used for bladder reconstruction. The choice of material for reconstruction is purely the surgeon′s prerogative--his skill, the ease, the mobility and length of mesentery (allowing bowel to reach the bladder neck without tension and maintaining an adequate blood supply). The presence or absence of concomitant reflux is of considerable importance. In the former, an ileocystoplasty with implantation of ureter to the proximal end of the isolated ileal loop and anastomosis of the distal end of the ileal loop to the bladder neck and trigone is advocated. In the latter case, the ureterovesical valve is preserved and colocystoplasty is preferred, wherein the sigmoid colon on being opened along its antimesentric border is joined to the trigone and bladder neck and then to itself to form a capacious pouch. Gastrocystoplasty reduces the risk of acidosis but is associated with complications like hypochloremic alkalosis and ′hematuria-dysuria′ syndrome. Orthotopic neobladder reconstruction is a feasible option, suitable in cases of tubercular thimble bladder with a markedly reduced capacity (as little as 15 ml), where an augmentation alone may be associated with anastomatic narrowing or poor relief of symptoms. In this article, we review the various bladder reconstruction options used for the surgical management of GUTB, along with their indications and complications.

Introduction: The systematization of surgical complications has long been a serious problem since different types of surgical procedures have specific complications, in addition to general consequences. Created in 1992 and improved in 2004, the Clavien-Dindo classification was successfully validated in surgical centers in different countries and recognized as an important tool for the qualitative assessment of surgical complications., Aim: To improve reconstructive procedures by systematizing complications based on the ClavienDindo classification., Materials and Methods: The results of substitution ileocystoplasty in 95 patients with contracted bladder due to tuberculosis and other diseases are presented. In 50 (52.6%) cases, the length of the bowel segment was 30-35 cm (group 1, main), while in 45 patients (47.4%) a segment of 45-60 cm was chosen (group 2, control)., Results: Early complications of grade II developed in 11 (22.0%) patients in the group 1 and in 13 (28.9%) in group 2, while grade III in 5 (10.0%) and 6 (13.3%) cases, respectively. Complications of IIIb grade were seen among patients of the main group in 9 (18.0%) cases compared to 12 (26.7%) in the control group. Severe complications of IVa and IVb grades were documented with the same frequency in both groups, in one case each. Complications of V grade (death) were recorded only in the group 2. Late complications were registered in 63 out of 94 patients. In group 1, there were 26 complications (16 somatic and 10 surgical), while in group 2, a total of 37 complications (24 somatic and 13 surgical) were seen, which indicates a significant higher rate in the control group (p<0.05). In group 1, transurethral resection of urethral-enteric anastomosis and ureteral reimplantation were performed less frequently than in group 2, while transurethral resection of the prostate was done with the same frequency. At the same time, percutaneous nephrostomy was required more often in the group 1 (6% vs. 4.5% in the group 2). After intestinal cystoplasty with a shortened fragment of the ileum, the voiding volume was significantly lower but corresponded to the physiological value (more than 150 ml). In this group, there was sufficient capacity of neobladder with a minimum amount of residual urine, effective emptying, satisfactory urinary continence, and low intraluminal pressure, which contributes to the protection of kidneys from reservoir-ureteral-pelvic reflux. The serum chloride level after surgery was 106.2+/-0.4 in the group 1 compared to 109.7+/-0.3 in the group 2, while base excess was -0.93+/-0.3 and -3.4+/-0.65, respectively (p<0.05)., Conclusion: Early serious postoperative complications according to Clavien-Dindo were registered with approximately the same frequency in both groups, while late complications developed significantly more often in the group 2. The urodynamic parameters of a neobladder formed from ileum segment of 30-35 cm are satisfactory. In addition, a decrease in the length of the intestinal segment prevents the development of hyperchloremic metabolic acidosis.

Background/Purpose Reconstruction of microbladders is a difficult surgical challenge: How can a neobladder be recreated when > 90% of the new bladder is augmented patch, and how can a Mitrofanoff conduit be anastomosed when the native bladder is so tiny? This series describes microbladders secondary to anuria and/or diversion that required augmentation. This was done using a de-tubularized ileal segment, and because of the small size of the native bladder, Mitrofanoff anastomosis was performed to the bowel patch (using a novel “Keel Procedure”). Methods Our surgical experience in reconstruction of microbladders was reviewed: pre and post augmentation capacity, compliance and maximum detrusor pressure were compared. The success of the Mitrofanoff anti-reflux technique is described. Data are given as median (interquartile range) and compared by Wilcoxon paired rank test. Results 10 patients, median bladder capacity pre-op 10 (9–20) mls were reconstructed. The follow up time is 2.7 years (2.2–4.2). Post-op bladder capacity increased 16-fold to 167 (114–281) mls, P < 0.01. Compliance significantly improved from 1.7 (0.3–4.8) to 14.3 (4.1–66.3) mls/cmH 2 O, P < 0.05. Maximum detrusor over-activity decreased from 27 (7–120) to 12.5 (8–26) cmH 2 O, (N.S. P = 0.3). Videourodynamics confirmed a leak in 2 patients, leading to incorporation into the technique of a non-absorbable seromuscular suture to provide long-term robustness to the antireflux procedure. Conclusion Bladder augmentation in microbladders is possible, and a functional Mitrofanoff procedure with a continent anti-reflux procedure can be created using the “Birmingham keel technique” implanting the Mitrofanoff into the augment patch, with 80% success (similar to published results for conventional anastomosis to native bladders). Level of evidence Level IV. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the new technique of Spiral-cap ileocystoplasty for bladder augmentation and simultaneous ureteric reimplant. Materials and Methods: Seven patients with small capacity bladder and simultaneous lower ureteric involvement operated in single tertiary care institute over the last 5 years were included in this study. Spiral-cap ileocystoplasty was used in all the patients for bladder augmentation. Proximal part of the same ileal loop was used in isoperistaltic manner for ureteric reimplantation. Distal end of this ileal loop was intussuscepted into the pouch to decrease the incidence of reflux. Detubularized distal portion of the loop was reconfigured in spiral manner to augment the native bladder. Patients were analyzed for upper tract changes, serum creatinine, bladder capacity, and requirement of clean intermittent self-catheterization in follow-up over 5 years. Results: There was no evidence of any urinary or bowel leak in the postoperative period. Recovery was equivalent with those treated with other methods of bladder augmentation. Follow-up ultrasonography showed good capacity bladder. Upper tracts were well preserved in follow-up. Urinary bladder and lower ureter pathologies were addressed simultaneously. Conclusion: Spiral-cap ileocystoplasty is a useful technique in patients who require simultaneous bladder augmentation and ureteric reimplant. [ABSTRACT FROM AUTHOR]

When medications and neuromodulation have failed to adequately treat pediatric bladders that are abnormal functionally or structurally, bladder reconstruction offers renal protection and the opportunity to achieve continence in carefully selected patients. Several surgical options, including incontinent and continent urinary diversion, bladder augmentation, and orthotopic neobladder, are available, using various bowel segments. Each has its own advantages, disadvantages, and complications based on the bowel segment's physiologic properties. While there is no consensus regarding the optimal age for bladder augmentation, the key to ensuring better outcomes and patient compliance is extensive preoperative counseling and close monitoring for compliance with catheterization and bladder irrigation. Additionally, long-term follow up is necessary to monitor for metabolic and nutritional issues and, rarely, malignancy. New techniques, including bladder tissue engineering and robot-assisted laparoscopic ileocystoplasty, are being explored. [ABSTRACT FROM AUTHOR]

It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.

Objectives To show the efficacy and safety of a novel modification of Studer's neobladder, herein defined as the 'fez procedure.' Methods The medical records of 21 children (mean age 9.4 ± 1.3 years) who underwent the 'fez procedure' at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, to manage refractory poorly-compliant bladders and concomitantly obstructed megaureters were retrospectively reviewed. The patients had been previously managed by either preliminary cutaneous ureterostomy (17 patients) or temporary nephrostomy (four patients) to improve and stabilize the renal functions. The 'fez procedure' entailed augmentation ileocystoplasty and the use of an afferent tubularized ileal loop for direct ureteroileal anastomosis. The augmented bladder together with the tubularized loop were fashioned as a 'fez' with its tassel. The outcome measures were changes in cystometric capacity, bladder compliance, glomerular filtration rate, serum creatinine, technetium 99m-diethylene triamine pentaacetic acid diuretic renography (T1/2), ureteral diameter, vesicoureteral reflux, febrile urinary tract infections, continence and complications. Results The mean study follow-up period was 52.5 ± 12.8 months. Means of changes of cystometric capacity (273.2 ± 60.9 mL) and bladder compliance (15.6 ± 4.2 mL/cm H2O) were significant ( P < 0.0001). Resolution of ureteral obstruction was documented with improved T1/2 and ureteral diameter ( P < 0.0001, each) of all patients. The initially improved renal functions after ureterostomies or nephrostomies were maintained after 'fez surgery,' with non-significant changes in the improved glomerular filtration rate ( P = 0.22) and serum creatinine ( P = 0.18). None of the patients experienced ureteral restenosis, vesicoureteral reflux, febrile urinary tract infections, incontinence or significant complications. Conclusions The 'fez procedure' represents a versatile and successful surgical option for these selected patients, as it offers improved bladder capacity/compliance, resolution of ureteral obstruction and vesicoureteral reflux, preservation of the renal function, control of urinary tract infections and urinary continence, and acceptable morbidity. [ABSTRACT FROM AUTHOR]

Some of the patients with genitourinary tuberculosis (GUTB) present to the urologist with small contracted bladders or with significant renal damage.[1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine. [ABSTRACT FROM AUTHOR]

The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/ monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction. [ABSTRACT FROM AUTHOR]

Aim: A comparison of long term outcomes in patients after gastrocystoplasty and ileocystoplasty and a comprehensive literature review to determine the risk of developing malignancy. Material and method: Between February 1990 and September 2006, 35 patients underwent 37 bladder augmentations. We compare the long-term outcome and overall morbidity of 17 patients after ileocystoplasty (ICPL) and 15 patients after gastrocystoplasty (GCPL). In the ICPL group, the median patient age at time of surgery was 12.5 years (5.8-19.2); primary diagnosis included neurogenic bladder and exstrophy/epispadia complex. In the GCPL group, the median age at time of surgery was 12.9 years (0.8-28.1); primary diagnosis was neurogenic bladder and exstrophy/epispadia complex. We retrospectively evaluated medical findings of the patients focusing on complications and long--term functional outcomes. Results: In the ICPL group, the mean follow-up time was 15.2 years. The mean cystometric bladder capacity increased from 122 to 401mL and the mean maximum intravesical filling pressure decreased from 59.4 to 30 cm of water. Complete urinary continence was achieved in 64.7% of patients. In the GCPL group, the mean follow-up time was 16.3 years. The mean cystometric bladder capacity increased from 121 to 327rmL and the mean maximum intravesical filling pressure decreased from 65.4 to 33.7cm of water. Full urinary continence was achieved in 60% of patients. The rate of febrile UTIs was 11.7% after ICPL and 20% after GCPL. Bladder stones developed in 11.7% patients after ICPL. Twenty percent of patients in the GCPL group had hematuria - dysuria syndrome. We also report on our original therapeutic experience using potassium citrate. One patient in each group required reaugmen-tation with a different segment of the gastrointestinal tract. One patient from the GCPL group died due to renal failure. No malignant bladder tumors were detected during the follow-up period. Conclusions: Long-term outcome of ICPL and GCPL are comparable. We have achieved satisfactory functional results despite significant morbidity which was slightly higher in the GCPL group. Patients require regular surveillance and long-term follow-up in order to protect renal function and maintain acceptable urinary continence. Due to the risk of malignancy in the augmented bladder, annual cystoscopy has been recommended starting at 10 years after augmentation. Urologists, who take care of these patients in adulthood, should follow this recommendation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the outcome of innervation preserving sphincteroplasty along with anatomical bladder neck reconstruction (IPS-ABNR) compared to classic Young-Dees-Leadbetter (YDL) bladder neck reconstruction in exstrophy with insufficient bladder capacity requiring detubularized-ileocystoplasty. Materials and Methods: Sixteen male patients of exstrophy bladder who required ileocystoplasty from 2004 to 2010 were randomized into group A (n = 7) and group B (n = 9). After detubularized-ileocystoplasty with Mitrofanoff stoma and ureteric reimplantation in all, group A received YDL bladder neck repair while group B received IPS-ABNR repair through a midline scrotoperineal approach. Outcome measurement included operative and postoperative problems, continence, and upper tract status. Results: In group A, two had incompetent bladder neck with gross incontinence, while four had a dry interval of more than 3 h without the ability of voiding per urethra. In group B, seven patients had dry interval of more than 3 h with an ability of urethral voiding and midstream holding in five. Conclusions: Exstrophy patients requiring augmentation cystoplasty and repaired with IPS-ABNR can achieve dynamic bladder outlet resistance with adequate leak point pressure and ability to void voluntarily with midstream holding capability. The children had the satisfaction of voiding per urethra with ability to stop in midstream similar to that in normal children. [ABSTRACT FROM AUTHOR]

Augmentation cystoplasty has been studied and performed by urologists for over 100 years. Although specific indications, techniques, and materials used have undergone major change and revisions during this period, the general concepts have remained unchanged. Bladder augmentation is used to 'augment' the bladder's ability to store. Specific indications include structurally diminished bladder capacity, neurogenically incapacitated bladder, special circumstances of overactive bladder and terminal cases of interstitial cystitis. As augmentation is mostly performed to improve capacity and to eliminate urinary incontinence, most failures relate to the inability to achieve this. Failure to achieve continence, improve bladder capacity or reduce bladder pressures with subsequent upper tract deterioration are results of failed augmentation cystoplasty. Underlying causes of these failures are described in this manuscript. [ABSTRACT FROM AUTHOR]

BACKGROUND: Augmentation cystoplasty is an accepted treatment modality for medically refractory neurogenic bladder dysfunction and malformed bladder by providing a highcapacity reservoir with low bladder pressure. A continent urinary diversion is often performed concomitantly for easier clean intermittent catheterization. METHODS: The patient records of 26 (m:w = 13:13; mean age 13 a) children who underwent augmentation cystoplasty between February 1995 and February 2011 were reviewed retrospectively. In follow-up, standardized interviews were performed and all patients underwent ultrasound, videourodynamic or voiding cystography and cystomanometry. Additionally, blood analyses (e.g. creatinine level, electrolytes and vitamin B12 level) were carried out. All complications were evaluated. RESULTS: Augmentation cystoplasty and continent urinary diversion were performed in 26 and 16 patients. Postoperative videourodynamic revealed a significant increase in bladder capacity (mean 569.7 ml; p-value < 0.001) and bladder compliance (mean 51 ml/cm HO; p-value < 0.001). Postoperatively 22 patients were socially continent. The most common complications were insufficiency and stricture of continent urinary diversion (56%;) and bladder calculi (23%;). One patient needed re-do of augmentation, due to a thrombosis of the ileocystoplasty, another developed intestinal obstruction and another showed insufficiency of the anastomosis, therefore a revision was performed. No malignancy was found. Renal function stayed stable in 25 children and improvement was found in 1 patient. CONCLUSIONS: Augmentation cystoplasty can increase the bladder volume and the bladder compliance. This procedure allows the majority of patients to achieve continence and to stabilize renal function. Careful follow-up is necessary for early recognition of complications e.g. malignancies and stones. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We investigated vitamin B12 deficiency following ileocystoplasty in children. Methods: Patients who underwent ileocystoplasty between December 1993 and September 2006 were included and B12 levels were retrospectively analysed. Patients with a serum B12 of less than 150 pg/ml were considered deficient. The distance of the ileal segment from the ileocaecal valve was recorded. Results: There were 105 patients in the series; 61 were male. Mean age at surgery was 7.7 years (SD = 3.9). The mean interval from surgery to most recent B12 level was 50 months (SD = 30). None of the patients were on B12 supplementation. Two patients were B12 deficient, both more than 7 years after surgery; 44% of patients with levels available 7 years after surgery had a B12 below 300 pg/ml. There was a significant negative correlation between B12 level and length of follow up (Spearman’s rank, P < 0.01). Twenty patients with an ileal segment sparing 60 cm from the ileocaecal valve had a higher mean B12 (524 vs 419, SEM 60 vs 28). This was not statistically significant. Conclusion: We demonstrate a reduction in serum B12 level with time following ileocystoplasty. These patients should have their B12 levels measured in the long term. [Copyright &y& Elsevier]

Lower urinary tract dysfunction can have a significant impact on patients with spinal cord injury. Over the years, many treatment options have become available. This article reviews the assessment and management of neurogenic detrusor overactivity, with a particular focus on articles from the recent literature. Recent guidelines on the subject will be discussed. Management options include antimuscarinics and bladder emptying measures, botulinum toxin A, and neuromodulation in refractory cases and surgery for intractable cases. Recent and relevant publications in these areas will be summarized and discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Incorporation of intestinal tissue into urinary tract elicits many metabolic and mechanical complications due to anatomical and physiological differences. Adipose-derived stem cells (ADSCs) improve vascularity and functional outcomes by a paracrine mechanism. In a pilot study we investigated whether ADSCs can survive in the augmented bladder and improve its function. Materials and methods: Autologous ADSCs were harvested from rat paragonadal fat and cultured before injection into a rat model of augmentation ileocystoplasty (study group). Control augmented bladders were injected with cell-free saline. Eight weeks later, rats underwent abdominal ultrasonography for upper tract changes and were examined by conscious cystometry to determine bladder function. After extirpation, augmented bladders were examined using Masson trichrome staining for connective tissue and muscle content, immunohistochemistry for α-smooth muscle actin, and rat endothelial cell antigen staining for endothelial cells. Changes in the extracellular matrix were assessed by determining the elastin content. ADSCs were labelled and tracked by 5-ethynyl-2-deoxyuridine nuclear staining. Results: Abdominal ultrasonography showed better preservation of upper tract function in the ADSC group than in the saline-treated group (P =0.007). After 2months there were no differences in the variables assessed by conscious cystometry between the ADSC and saline-treated groups. However, the bladder weight was significantly greater in the ADSC-treated group. On immunohistochemistry, the implanted ADSCs survived up to 8weeks but did not transdifferentiate into smooth muscle or endothelial cells. Conclusion: These results suggested a potential role of ADSCs in modifying the intestinal segment in augmented bladders; this role has to be further elucidated. [Copyright &y& Elsevier]

Purpose: To evaluate the application of a reversed intact ileal patch for augmentation cystoplasty in terms of improvements in bladder urodynamics and to eliminate the need for bowel anastomosis in an experimental model. Methods: 12 cross-bred adult dogs were used for reversed seromuscular ileocystoplasty with intact bowel segment. The procedure was comprised of selecting a 7- to 10-cm ileal loop from about 20 cm proximal to the ileocecal valve. The seromuscular layer of the ileal loop from its antimesenteric aspect was sutured to the bladder mucosa of the previously bivalved bladder with running stitches. Results: 10 animals survived and completed their 4-week follow-up period. Postoperative urodynamic study revealed a 26% increase of mean maximal cystometric capacity [from 226 to 285 ml (p = 0.002)] and a significant increase in mean bladder compliance [from 11.8 to 17.8 ml/cm H2O (p = 0.002)]. Mean maximal detrusor filling pressure decreased significantly from 20 to 16.1 cm H2O (p = 0.011). Histopathologic examination of the augmented bladder showed complete epithelialization of the serosal surface of ileum with layers of transitional urothelium. Conclusions: The early results of this less invasive technique were promising in terms of improvements in bladder urodynamic variables and growth of transitional urothelium. Longer follow-up is necessary to show the durability of these effects. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

lthough more conservative measures are used as first-line treatment of patients with overactive bladder and for those with small capacity, low-compliance bladders, augmentation cystoplasty remains an essential tool for patients who fail conservative therapy. The goal of augmentation cystoplasty is to provide a low-pressure reservoir with adequate capacity while preserving urinary continence and renal function. [ABSTRACT FROM AUTHOR]

Augmentation cystoplasty has traditionally been used in the treatment of low capacity, poorly compliant or contracted bladders. Various bowel segments can be used for augmentation with its own advantages and disadvantages like ileum, sigmoid, cecum, ileo cecal, stomach etc. The surgical technique involves detubularisation and reconfiguration of bowel to create a patch. A successful clinical outcome depends on creating a large capacity, low pressure reservoir to store urine. Present study was retrospective study conducted from November 2010 to March 2014 on 7 patients (5 men, 2 women with mean age 32 years). Early complications: wound infection in 3 cases, wound dehiscence in 2 cases, urinary leakage in 1 case. Late complications: recurrent UTI in 2 cases, increased mucus production in one case, bladder stone formation in one case. All were grade I to III according to Clavien-Dindo classification. No major (grade IV or V) complications. As in our experience ileocystoplasty for augmentation of tuberculous bladder is a safe and effective procedure. [ABSTRACT FROM AUTHOR]

We present the University of Chicago technique for complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy. The operative steps of the open procedure were replicated laparoscopically using robotic assistance. Initially, five transperitoneal laparoscopic ports are placed prior to docking the da Vinci S robotic system. A 20 cm ileal segment is isolated, and the gastrointestinal anastomosis is performed in an end-to-end fashion using intracorporeal suturing. The appendix is anastomosed to the right posterior wall of the bladder over an 8F feeding tube in an extravesical fashion. Then, the bladder is incised in a coronal plane, and the simple detubularized ileal on-lay patch is anastomosed to the posterior and anterior walls of the bladder. A suprapubic catheter and pelvic drain are placed. Finally, the Mitrofanoff stoma is then fashioned. Cystography is done at 4 weeks postoperatively. This report suggests that robotic-assisted ileocystoplasty and appendicovesicostomy is feasible. A reasonable outcome with early recovery, resumption of normal activities, and excellent cosmesis can be achieved in select patients. A large case series, however, is necessary to determine whether a robotic-assisted approach provides any significant advantages over conventional open procedures. [ABSTRACT FROM AUTHOR]