Question

Discuss indications and techniques of augmentation cystoplasty.

Hint:

Augmentation cystoplasty can significantly improve bladder function, but it is associated with potential risks, including infection, metabolic complications, and long-term need for catheterization.

Answer 1

Augmentation cystoplasty is a surgical procedure used to enlarge the bladder capacity, especially in cases of bladder dysfunction or reduced bladder capacity. It is commonly performed for conditions such as neurogenic bladder, bladder fibrosis, and congenital bladder anomalies.
Step 1: Indications for Augmentation Cystoplasty:
- Neurogenic Bladder: In patients with spinal cord injury or other neurological conditions causing impaired bladder function, augmentation cystoplasty can improve storage capacity and reduce the need for frequent catheterization.
- Bladder Outlet Obstruction: Patients with bladder outlet obstruction (e.g., secondary to prostate enlargement, urethral stricture) may require bladder augmentation if they have reduced bladder capacity.
- Congenital Abnormalities: Conditions such as bladder exstrophy or posterior urethral valves, which result in a small bladder capacity, may be treated with augmentation cystoplasty to restore normal function.
- Refractory Interstitial Cystitis: Augmentation cystoplasty is considered when conservative treatments fail to manage severe cases of interstitial cystitis.
- Bladder Cancer: After partial cystectomy, augmentation cystoplasty can be performed to restore bladder function and increase capacity if needed.

Step 2: Techniques of Augmentation Cystoplasty:
- Ileocystoplasty: The most common technique, where a segment of the ileum is used to augment the bladder. The segment of ileum is isolated, and its lumen is connected to the bladder. This method offers good tissue compliance and allows for substantial bladder enlargement.
- Cecocystoplasty: In this technique, a segment of the cecum is used for bladder augmentation. It is less commonly performed but may be considered in certain cases when a large segment of bowel is required.
- Colon Cystoplasty: A portion of the colon may be used for bladder augmentation, particularly when large augmentation is necessary. The colon provides a large, compliant segment but has a higher risk of complications like mucus production and infection.
- Other Techniques: Various techniques can be adapted depending on the patient’s anatomy and the extent of augmentation required, such as the use of stomach or small intestine for bladder enlargement.

Step 3: Postoperative Considerations:
Postoperatively, patients need careful monitoring for complications such as infection, bleeding, or metabolic imbalances (electrolyte disturbances, particularly if bowel is used). Additionally, patients may require intermittent catheterization, and long-term follow-up is necessary to monitor for complications like stone formation or urinary tract infections (UTIs).