Our experience with ileocystoplasty for augmentation of tuberculous bladders

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.

Outcome of de-mucosalized ileocystoplasty combined with strengthened pelvic floor in patients with neurogenic bladder / 中华泌尿外科杂志

Objective To assess the outcome of de-epithelialied ileocystoplasty combined with strengthened pelvic floor in patients with neurogenic bladder.Methods Twelve patients (9 male,3 female) aged from 18 -27 years (averaged 25 years) with neurogenic bladder received de-mucosalized seromuscular ileocystoplasty combined with strengthened pelvic floor,and were evaluated by urodynamic parmeters,upper urinary tract image appearance,and serum creatinine before and one year after operation.Results After operation,the max cystometric capacity (412 ± 32 ml),bladder compliance (26.2 ± 4.0ml/H2O),relative safety cystometric capacity (368 ±26 ml) and max flow rate (20 ±3 ml/s) were respectively significantly higher than those preoperation(247 ±27 ml,4.4 ± 1.2 ml/cm H2O,206 ±24 ml,11 ±2ml/s,P ＜ 0.05).Moreover,the post voided residual (26 ± 8 ml) and detmsor leakage point pressure (17.8 ±3.6 cm H2O) were significantly lower than those of preoperation (136 ± 25 ml,63.1 ± 4.9cm H2O,P ＜0.05).The vesicoureteral reflux disappeared in five (63％) cases,and was relieved in the remaining three cases.Of the five cases with renal insufficiency,three (60％) cases had normal serum creatinine level,none had increased serum creatinine levels.After operation,late healing occurred in two ( 17％ ) cases,intestinal obstruction in one (8％),vesicoabdominal fistula in one (8％),and no cases had mucous urine.Clean intermittent self-catheterization was performed in one case (8％) to empty the bladder due to a fever resulting from urinary tract infection,the remaining 12 (92％) cases could empty their bladders through abdominal pressure.Conclusions De-mucosalized seromuscular ileocystoplasty combined with strengthened pelvic floor results in a good outcome for the patients with neurogenic bladder.

Resultados de la ileocistoplastia ortotópica en pacientes con tumor vesical / Orthotopic ileocystoplasty results in patient presenting vesical tumor

INTRODUCCIÓN. El cáncer de la vejiga es considerado un problema de salud tanto en Cuba como en el mundo. La cistectomía radical y sus variantes terapéuticas tienen la finalidad de curar o controlar la enfermedad, y conllevan la creación de un reservorio lo más semejante posible a la vejiga, por lo que se trabaja en la creación y perfeccionamiento de neovejigas a partir de un segmentointestinal. El objetivo de esta investigación fue evaluar los resultados de la ileocistoplastia ortotópica como procedimiento derivativo de la orina, después de la cistectomía total. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo y prospectivo de 40 pacientes tratados en el Hospital Hermanos Ameijeiras, en La Habana, entre los años 2000 y 2008. La fuente de información fueron los expedientes clínicos de los pacientes, y los datos se procesaron por medios automatizados. RESULTADOS. La mayor incidencia se encontró en los pacientes con 65 años de edad. La enuresis fue la forma de incontinencia urinaria que predominó y la mayoría de los pacientes tenían micciones voluntarias. Siete pacientes presentaron hidronefrosis y las fístulas del reservorio se relacionaron con la radioterapia. La mortalidad fue del 7,5 por ciento. CONCLUSIONES. La ileocistoplastia ortotópica es un sustituto vesical aceptable en los pacientes con tumores vesicales(AU)

INTRODUCTION: The bladder cancer is considered a health problem in Cuba and worldwide. The aim of radical cystectomy and its therapeutical variants is to cure or control the disease and it is necessary the creation of a reservoir very similar to bladder and nowadays it is working in creation and improvement of the neo-bladders from an intestinal segment. The aim of present research was to assess the orthotopic ileocystoplasty results as urine derivative procedure after total cystectomy. METHODS: A prospective, retrospective and descriptive study was conducted in 40 patients seen in Hermanos Ameijeiras Clinical Surgical Hospital of Ciudad de La Habana between 2000 and 2008. The information's source was the patient clinical expedients and data were processed by automated means. RESULTS: The higher incidence was found inpatients aged 65. Enuresis was the predominant urinary incontinence and most of patients had voluntary urination. Seven patients had hydronephrosis and reservoir fistulae were related to radiotherapy. Mortality rate was of 7,5 percent. CONCLUSIONS: Orthotopic ileocystoplasty is a acceptable vesical substitute in patients presenting with vesical tumors(AU)

Application of low abdominal external urethroplasty in ileocystoplasty / 中国基层医药

Objective To rebuild artificial external urethroplaspy and improve collecting-urine method for the patient with ileocystoplasty.Methods Abdominal tube shaped artificial external urethra were rebuilt by designing two reverse ladder shaped skin flaps,using synthetic tube shape as covering,and using distant ileum flap as lining in total cystectomy and ileocystoplasty for 17 patients with urinary bladder carcinoma during August 1993 to July 2005.Urine was collected by connecting tube shaped external urethra with condom and urine package.Results The operation of 17 artificial external urethra succeeded all.The wound of the operation healed one stage.Urine collecting was easy and less contamination.Conclusion Artificial external urethroplasty with lower abdominal wall skin-flap and ileum-flap is simple,safe,and suitable to the patients with ileocystoplasty.Urine collecting is convenient and hygiene and low-price.

The Pharmacological and Histological Comparison Between Detubularized and Tubularized Cystoplasty Ileum in the Rat / 대한비뇨기과학회지

Bowel segments are used either in a tubular or detubular configuration in bladder augmentation and substitutions. The majority of urologists agree that detubularized segments give better clinical results,but detailed studies were not investigated in animals. The present study compared the contractile response of autonomic agonists including carbachol, isoproterenol,alpha, beta-methylene ATP on detubularized and tubularized cystoplastic ileal segments. In addition, histological examinations of cystoplastic ileal segments were performed. Five rats underwent Sham operation as control and eight rats underwent detubularized ileocystoplasty and seven rats underwent tubularized ileocystoplasty. Analysis was done six weeks after surgery. The contractile responses of detubularized cystoplasty ileum to carbachol, alpha, beta-methylene ATP were significantly increased when compared to the responses of tubularized ileum and control ileum. The relaxation responses of detubularized cystoplasty ileum to isoproterenol were significantly higher than control ileum. However, in tubularized ileum, the responses to carbachol, alpha, beta-methylene ATP, isoproterenol were similar for control ileum. The responses of detubularized cystoplasty ileum to carbachol, alpha, beta -methylene ATP were significantly different from control bladder, but detubularized cystoplasty ileum showed responses that resemble control bladder more closely when compared to the responses of tubularized ileum.The histological examination showed urothelialization of cystoplastic ileum with transitional epithelium extending over and covering the junction margin of the cystoplastic ileum. These results suggest detubularized ileocystoplasty induced closer pharmacological changes in the ileal segment towards the bladder than tubularized ileocystoplasty and so we can expect detubularized ileocystoplasty gives better clinical outcome.

The effect of iodine solution for reducing mucosal secretion in augmentation ileocystoplasty in rats / 대한비뇨기과학회지

With the increasing use of intestinal segment for bladder substitutes or augmentation, excessive mucus secretions secreted by goblet cells in the transplanted intestinal mucosa elicits various problems in patients. During ileocystoplasty, three kinds of concentration of iodine solution (0.5 %, 0.25 %. 0.125 %) were applied on the mucosa of ileal segment for reducing mucosal secretion. 24-hour urine was collected for each rat weekly and then cystectomy was performed at 4 weeks after ileocystoplasry. The amount of lyophilizod dry mucus was increased in 2-3 weeks and decreased thereafter, and it was significantly lower in the group using 0.25 % iodine solution than in other groups. Fibrosis was not significant in all experimental rats compare to control group by Masson-trichromr staining. With this method further investigation will be needed for reducing the mucus secretion.

The effect of octreotide, a ling-acting somatostatin analogue, on the reduction of mucosal secretion after ileocystoplasty in rats / 대한비뇨기과학회지

The use of isolated intestinal segments is currently the best method of augmenling bladder capacity. Pedicled segments of ileum and colon used in lower urinary tract reconstruction retain their normal neurovascular input and might be expected to retain their physiological function despite their new anatomical situation. The mucus secreted mostly by goblet cells in the grafted intestinal mucosa elicits various problems in patient management. This study was attempted to evaluate the effect of octreotide, a long-acting somatostatin analogue on the mucosal secretion. The animals, weighing 250-320gm, were divided into 2 groups: control group, in which only ileocystoplasty was done, and octreotide injection group after ileocystoplasty. Oclreolide was injected daily S.C. 0.002 micrometer/gm after posloperalive 1 week. Cystectomies were performed at postoperative 1. 2, 3, 4 weeks. Histopathologic examination of the ileocystoplasty specimens was done by light microscopy after PAS reaction. 24-hour urine was collected for each rat weekly and then the amount of lyophilized dry mucus in urine was measured. The number of goblet cells within 10(3) micrometer2 of mucosal epithelium in the grafted ileal segments were evaluated by morphometric analysis using an image analyzer. The results were as follows: 1. Microscopically, transitional epithelium extended well over the intestinal mucosa through the anastomotic site at both 4 weeks groups. 2. The amount of urinary lyophilized dry mucus at control group was increased at postoperative 2. 3 weeks (64.2 mg, 67.7 mg) and decreased at 4 weeks (32.7 mg). After octreotide injection, the amount of lyophilized dry mucus significantly decreased when compared with the control group at 2, 3 weeks (15.2 mg, 18.9 mg, p<0.01) 3. The number of goblet cells within 10(3) micrometer2 of mucosal epithelium in control group was increased at 2. 3 weeks after operation (1.94+/-0.31, 2.19+/-0.36) and decreased at 4 weeks (1.61+/-0.25). After octreotide injection. The number of goblel cells significantly decreased when compared with the control group at 2, 3 weeks (1.28+/-0.36, 1.54+/-0.26, p<0.01). These results suggest that octreotide may be effect on the reduction of mucosal secretion after ileocystoplasty. Further investigation using this method will be needed for clinical application.

4 Cases of Hemi-Kock Ileocystoplasty / 대한비뇨기과학회지

Augmentation cystoplasty is effective in the rehabilitation of the contracted bladder of small capacity caused by tuberculosis or interstitial cystitis refractory to more conservative methods of management. Genitourinary tuberculosis is the most common cause of contracted bladder in Korea and it may lead to considerable vesicoureteral reflux and progressive deterioration of renal function. The use of hemi-Kock ileal pouch with an afferent intussuscepted nipple is a suitable solution in patient in whom the bladder outflow tract provides adequate resistance and supratrigonal cystectomy is to be performed with construction of an antireflux mechanism. Herein, we report 4 cases of hemi-Kock ileocystoplasty.

Clinical Observation and Follow-up Study on Ileocystoplasty / 대한비뇨기과학회지

Augmentation ileocystoplasty is the most available method of enlargement of capacity for the contracted bladder by using the intestinal segment. Contracture of bladder is the result of chronic vesical infections such as tuberculosis, interstitial cystitis, radiation cystitis, or neurogenic bladder, among them tuberculosis is the most common cause of bladder contracture in Korea. Contracted bladder usually demands active correction, while it may lead to considerable vesicoureteral reflux and deterioration of renal function. Herein we describe a clinical observation and follow-up study for more than 2 years on the 5 cases of augmentation ileocystoplasty, which we experienced during the periods from December 1978 to November 1980.

A Clinical Study on Urinary Diversion and Reconstruction of the Urinary Tract with the Intestine / 대한비뇨기과학회지

In the field of urological surgery, the use of bowel has been established as methods of urinary diversion or reconstruction of urinary tract since ileal conduit was settled by Bricker in 1950. Urinary diversion or reconstruction with use of bowel segment is usually performed for the purposes of life saving and social adaptation of patients by removal of tumor itself and by preservation of renal function and normal urination. A favorable prognosis can be expected by urinary diversion utilizing a intestinal segment after removal of bladder and its surrounding tissues for the therapy of bladder carcinoma. In Korea, where tuberculosis is prevailing, interests of many urologists are centered on the preservation of bladder capacity for the treatment of contracted bladder complicating tuberculosis of urinary tract. But until recently, only a few experimental or clinical studies on urinary diversion and reconstructs on with use of the intestinal segment were reported in this country. A clinical observation was made on I7 cases of urinary diversion or reconstruction with use of the intestinal segment, which were performed on the patients admitted to the Department of Urology, Severance Hospital in 1977. The results are as follows: 1. The age distribution of patients was from 4th, to 6th. decades. 2. Among the patients, 13 cases were male and 4 cases were female bladder tumor were male. 3. The patients were consisted of 11 cases of bladder tumor, 5 cases of tuberculous contracted bladder and 1 case of a large vesicovaginal fistula 4. In operations, ileal conduit for 11 cases of bladder tumor, ileocystoplasty for 5 cases of tuberculous contracted bladder and ureterosigmoidostomy for 1 case of a large vesicovaginal fistula were performed. Acccmpanyingileal conduit, total cystectomy was performed in 10 cases end ligation of biateral hypogastric arteries only in the rest.5. In bladder tumor, comparing with pathological staging, the number of clinical understating and overstaging were 5 and 2 cases respectively. The pathological stages were not significantly correlated with the grades. 6. After ileocystoplasty for tuberculous contracted bladder, the intervals of urination was prolonged to 2 hours or more and improvement of incontinence was noted in all cases. 7. The blood levels of urea nitrogen and creatinine returned to normal except 1 case complicated with infection of urinary tract after operation. 8. The mean volumes of transfused blood during operation were 1,026ml for ileal conduit with total cystectomy, and 664ml for ileocystoplasty. The mean operation time was 5 hours and 56 minutes for ileal conduit with total cystectomy and 5 hours and 12 minutes for ileocystoplasty 10. The average postoperative duration were 18 days in ileal conduit with total cystectomy and 17 days in ileocystoplasty. 11. The postoperative complications included 5 cases of wound infection, 5 cases of urinary tract infection, 3 cases of paralytic ileus or mechanical ileus and 2 cases of urine leak.

Clinical Observation on 24 Cases of Ileocystoplasty and Ileal Conduit / 대한비뇨기과학회지

No abstract available.

Ileocystoplasty for Contracted Bladder: A Case Report / 대한비뇨기과학회지

Contracture of the bladder resulting in diminished vesical capacity is not common and it demands correction as it leads to renal deterioration. Tuberculous infection, the most frequent type, is a chronic, cicatrizing inflammation of the bladder that is responsible for bladder contracture. Herein, the author describes an experience with a young male patient whose bladder capacity was less than 30cc. and left Kidney was non-functioning following anti-tuberculosis chemotherapy of irregular and random period for renal tuberculosis. Ileocystoplasty was performed at the Department of Urology, Presbyterian Medical Center, Taegu, Korea on the patient with good results; considerable relief of symptoms following surgery.

Experimental Study on Ileocystoplasty: 1. A New Technique of Ileocystoplasty: Two Layer Open-flap Method / 대한비뇨기과학회지

The treatment of bladder contraction remains as one of the most difficult problems in urological field today despite numerous attempts to overcome this difficulty. Many etiologic factors can be elicited as for the cause of such contractions; more common and important ones being interstitial cystitis, tuberculous infection, various chemical and radiation damages etc. Extensive subtotal bladder resection may also result in limited fluid capacity. All of these can produce severe urinary symptoms of frequency and incontinence and further bilateral renal damages. Until recently the prevalent treatment for the disease complex caused by contracted bladder was diversion of urine either to large bowel or skin, or the use of an indwelling urethral catheter. eliminating the bladder as a reservoir. Although these techniques were proven to be valuable for a certain extent there have been many undesirable aspects. Among the undesirable aspects of diversion of urine are 1. recurrent chronic pyelonephritis caused by organisms from the skin or feces. 2, hydronephrosis from stricture of anastomotic sites, and 3. electrolyte imbalance following transplantation of ureter to bowel. The use of an isolated intestinal segment to segment bladder capacity merits s serious consideration, and the technique of ileocystoplasty may be a possible solution to these difficultise. Results of recent reports on clinical and experimental application of this technique are promising though their methods vary greatly. In the majority a closed tube was anastomosed to the bladder in varying positions but some applied the ileum as an open sheet. The latter method was applied by some in the belief that on open patch of ileum would empty itself more efficiently than a closed type since closed type of ileocystoplasty frequently retained urine. However, control of bleeding during preparation of ileal open sheet have been a major difficulty for application of an open-sheet technique. The purpose of this investigation was to develop a new technique for augmentation of bladder capacity in physiologic manner with diminution of bleeding during the procedure. MATERIALS AND METHODS: Healthy eight Korean dogs weighing from 15 to 18kg were used. Female dogs were exclusively utilized for the convenience of urinary drainage and catheterization postoperatively. pregnant dogs were not used. In each dog, the bladder was mobilized and then subtotally resected leaving one third of the normal bladder. The level of excision was just above the trigone sothat the ureteral orifices were undisturbed. A 20cm segment of ileum approximately 20cm, from the ileocecal valve was isolated with an intact pedicle of mesentery. The continuity of the bowel was restored by end-to-end anastomosis. The isolated ileum was folded at the middle portion with two clamps each placed on half of isolated segment in length for control of bleeding when incision was made on stitch type and then a cap type of ileal bladder with two layers was sutured to the bladder stump by a mucosa-to-mucosa technique forming a bladder composed principally by ileum. The peritoneal cavity was closed without drainage.In the immediate postoperative period urinary drainage was maintained by urethral catheter. RESULTS AND SUMMARY: l. Eight dogs were subjected to ileocystoplasty by the use of two layer ileal open flap. One of them expired because of an accident and seven others survived without incident. 2. The use of the clamps on ileal segment was reliable in controlling bleeding for wider incision to make open ileal flap. 3. Ratio of augmentation of bladder capacity by this technique was twice of that by closed loop technique. 4. The fluid capacity of reconstructed bladder of this technique approached to the tidal capacity 5. One patient with contraction of bladder due to tuberculosis has been satisfactorily palliated by this technique.

Experimental Study on Ileocystoplasty: 2. Production of Collateral Blood Supply to the Ileac Segment After Ileocystoplasty / 대한비뇨기과학회지

The use of isolated segment of ileum as urinary conduits has found wide acceptance in recent years in urological field. The procedures by various investigators have been proven valuable by fairly extensive clinical trial. However, to achieve a satisfactory ileocystoplasty by a viable flap serious consideration should be given to the lymphatic and vascular factors involved in this procedure. It was therefore decided to observe carefully a production of collateral blood supply to the ileal segment after ileocystoplasty. MATERIALS AND METHODS: Healthy 9 Korean dogs: weighing from 15 to 30 kg were used. One animal was used for a preliminary study. The two layer open flap ileocystoplasty previously described was performed in four dogs and the other four dogs received ringplastic type operation. All of the animals were divided into our different groups to receive different manipulation. In the first group of two dogs. the blood supply to the ileal segment from its mesentery was clamped, cut and ligated immediately after each procedure. In the second group of two dogs cessation of blood supply was performed as above 2 weeks after ileocystoplasty. In the third group of two dogs, the same have been done 4 weeks after the initial operation. The last group of two dogs 8 weeks elapsed before interruption of blood supply was carried out. Animals were sacrificed two weeks after interruption of blood supply from mesentery and gross and microscopic studies were made. RESULTS AND SUMMARY: 1. When the blood supply to the ileal bladder from its mesentery was interrupted immediately after ileocystoplasty, animals expired in 3 to 6 days suffering from gangrene of the ileal segment. Purulent exudate was present between the ileal segment and urinary bladder. 2. When the blood supply to the ileal bladder was interrupted 2 weeks after ileocystoplasty. animals survived and were found to have undergone spontaneous omentopexy but anastomosed ileal segment appeared not viable because of atrophy. 3. When cessation of blood supply was done 8 weeks after ileocystoplasty, animals made an uneventful postoperative recovery and the ileal segment and urinary bladder appeared normal with good collateral circulation from omentum and original bladder 4.There was no significant difference among the types of ileocystoplasty in the formation of collateral blood supply.

Experimental Study on Ileocystoplasty: 3. Function of Bladder after ileocystoplasty / 대한비뇨기과학회지

The purpose of ileocystoplasty is to augment bladder capacity and the reconstructed bladder must not only be able to empty but also be able to contain urine in a physiologic manner. Low intravesical pressure with minimum reabsorption of electrolytes is desirable. In previous studies I have described a new reliable technique of ileocystoplasty with a satisfactory clinical application. The purpose of this study was to evaluate the physiologic aspects concerning several different types of ileocystoplasty. METHODS AND RESULTS: Healthy 8 Korean dogs were utilized. The animals weighed from 15 to 20kg. The two layer open flap method of ileocystoplasty was performed in four dogs and the other four dogs received ring plastic type. Intravesical pressure was measured by a water manometer and all measurements were read directly from the manometer tube. In order to obtain standard controls cystometrograms were done in 3 normal dogs. The normal dog bladder was found to respond to increased intravesical fluid and the average bladder capacity was 130cc. The voiding pressure was 28cm in water. The average fluid capacity of the reconstructed bladder was 120cc in two layer open flap method and 150c. c. in ring plastic method. The cystometry 10 minutes after intermuscular injection of 1.0cc. of 1:2000 prostigmin solution disclosed a definite increase in vesical fluid pressure in ring plastic type whereas the two layer open flap type did not show any elevation. Administration of 0.4mg of atropine intramuscularly decreased intravesical pressure in ring plastic type but was not significant in two layer open flap type. Injection of 10cc. of 0.25% pentothal sodium intravenously caused decrease of fluid pressure in both types. Emptying activity of the reconstructed bladder was measured by x-ray retrograde cystogram methods. The opaque medium remained in the ileal loop for 24 hours after onset of voiding in ring plastic type but no opaque medium was seen in the two layer open flap type. Absorption of electrolytes from the bladder after the two layer open flap ileocystoplasty was not altered significantly. The postoperative electrolyte plasma values of potassium and sodium chlorides were within normal limits. Histologic examinations of the ileal bladder 2 months after the open flap ileocystoplasty disclosed varying degrees of non-specific inflammatory reactions. No metaplasia or loss of mucous glands was seen.