Our Summary

This research paper is a review of a surgical procedure called augmentation cystoplasty (AC), which is used in patients with a condition called neurogenic bladder - a bladder dysfunction caused by nerve damage. The researchers looked through several databases to find articles on this subject.

AC is mostly used in cases where the bladder is overactive or doesn’t respond well to usual treatments. These treatments include certain medications and injections. The surgery can be done in several ways, for example, using parts of the intestine or other tissues, or synthetic materials. However, using a part of the intestine is the most effective method. A common type of AC is ileocystoplasty, which involves using a specific part of the intestine and attaching it to the bladder.

Some patients might need additional surgeries at the same time as AC, for instance, to help with catheterization, treat reflux, or deal with incontinence. After the surgery, most patients see improvements in bladder capacity, functioning, and control. Most also experience a better quality of life. However, there are some serious complications that can occur, such as chronic urinary tract infections, stones in the bladder or kidneys, metabolic issues, bowel problems, rupturing, and cancer. There is also a high chance of needing more surgeries, especially if the patient had a catheterizable channel created during the AC.

Although using a part of the intestine for AC is the best method so far, more research is needed to understand the risks of different techniques and when additional surgeries should be done. There are also promising experimental methods that use tissue engineering, which need further investigation.

FAQs

  1. What are the indications for augmentation cystoplasty (AC) in patients with neurogenic bladder (NGB)?
  2. What complications can occur following augmentation cystoplasty (AC)?
  3. What improvements can patients expect after undergoing augmentation cystoplasty (AC)?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bladder surgery is to carefully follow post-operative instructions, including proper catheter care, hygiene, and medication management to reduce the risk of complications and promote healing. It is also important to attend all follow-up appointments to monitor recovery progress and address any concerns promptly. Additionally, maintaining a healthy lifestyle, including staying hydrated and following a balanced diet, can help support optimal bladder function after surgery.

Suitable For

Patients with neurogenic bladder (NGB) who have an overactive or poorly compliant bladder that is refractory to conservative therapies, such as anticholinergic medications and bladder botulinum toxin injections, are typically recommended bladder surgery. These patients may experience symptoms such as urinary incontinence, urinary retention, recurrent urinary tract infections, and renal damage.

Augmentation cystoplasty (AC) is a surgical procedure that is commonly recommended for these patients. AC involves increasing the size of the bladder by using a segment of the patient’s own bowel or other tissues to create a larger bladder capacity. This can help improve bladder function, reduce symptoms, and improve quality of life for patients with NGB.

Patients who undergo AC may also require additional surgeries at the same time, such as creating a catheterizable channel for clean intermittent catheterization, treating vesicoureteral reflux with ureteral reimplantation, or addressing incontinence with a bladder outlet procedure.

While AC can significantly improve bladder function and quality of life for patients with NGB, it also carries risks of complications such as chronic urinary tract infections, bladder and renal calculi, metabolic disturbances, bowel problems, perforation, and malignancy. Patients who undergo AC may also require follow-up surgeries, especially if they have concomitant procedures at the time of the initial surgery.

Overall, AC is a valuable treatment option for patients with NGB who do not respond to conservative therapies, but it is important for patients and healthcare providers to carefully weigh the potential benefits and risks of the procedure before proceeding. Further research is needed to better understand the long-term outcomes and complications of AC, as well as the indications for concomitant surgeries and new experimental techniques in tissue engineering.

Timeline

Before bladder surgery, a patient with neurogenic bladder may have already tried conservative therapies such as anticholinergic medications and bladder botulinum toxin injections without success. They may have undergone various tests and evaluations to determine the best course of treatment. The decision to undergo augmentation cystoplasty (AC) is typically made after careful consideration of the patient’s symptoms and overall health.

During the surgery, the patient will undergo a procedure where a portion of their intestine (usually the ileum) is used to create a larger bladder. This involves detubularizing the patch of intestine and connecting it to the existing bladder. Depending on the patient’s specific needs, additional procedures such as creation of a catheterizable channel, ureteral reimplantation, or bladder outlet procedure may be done simultaneously.

After the surgery, most patients experience improvements in bladder capacity, compliance, and continence. This often leads to an overall improvement in quality of life. However, there are also significant complications associated with AC, including chronic UTIs, bladder and renal calculi, metabolic disturbances, bowel problems, perforation, and malignancy. Follow-up surgeries may be necessary, especially if a catheterizable channel was created during the initial procedure.

Overall, AC remains the gold standard for treating neurogenic bladder in patients who do not respond to conservative therapies. More research is needed to better understand the long-term outcomes and complications associated with different surgical techniques, as well as the indications for concomitant surgeries. Experimental methods using tissue engineering show promise for the future of AC.

What to Ask Your Doctor

  1. What are the reasons for recommending bladder surgery in my case?
  2. What are the different types of bladder surgery available for my condition?
  3. What are the potential risks and complications associated with bladder surgery?
  4. What is the expected outcome of the surgery in terms of bladder capacity, compliance, and continence?
  5. Will I need any additional procedures or surgeries in conjunction with the bladder surgery?
  6. What is the typical recovery process and timeline after bladder surgery?
  7. How often will I need follow-up appointments after the surgery?
  8. Are there any long-term effects or complications I should be aware of after bladder surgery?
  9. Are there any alternative treatments or therapies that could be considered instead of bladder surgery?
  10. What is the success rate of bladder surgery in patients with similar conditions to mine?

Reference

Authors: Cheng PJ, Myers JB. Journal: World J Urol. 2020 Dec;38(12):3035-3046. doi: 10.1007/s00345-019-02919-z. Epub 2019 Sep 11. PMID: 31511969