V266: Technique & depiction of the augmentation ceco-cystoplasty continent urinary diversion procedure
VideoIntroduction and Objectives
Urinary incontinence has significant physical, sociological, and psychological implications. Furthermore, Neurogenic bladder management signifies one of the most distressing conditions of incontinence to treat. Medical and minimally invasive therapeutic modalities often cease to alleviate the incontinence as the condition causing it progresses. Surgical modalities involving bladder diversion and augmentation allow for improved urine control and patient autonomy with minimal risks resulting in significant improvement in the quality of life.
This is a video demonstrating the steps suggested for performing an augmentation ceco-cystoplasty continent urinary diversion.
Upon entry into the peritoneal cavity, the ileocecal junction is identified and the bowel mesentery of the bowel segment to be utilized is isolated and ligated. The colon is transected close to the cecum while the ileum is transected 15 cm proximal to the ileocecal junction. The rest of the bowel is anastomosed. The cecal side of the isolated bowel is opened and irrigated with antibiotic solution with the opening involving the whole anti-mesenteric border to create a cecal patch for the bladder augmentation. The ileal side is then opened and tapered over a 16 French red rubber catheter. The ileocecal valve is then plicated to reinforce the continence mechanism. The bladder is bivalved & sutured to the cecum patch using absorbable sutures. A large caliber suprapubic tube is inserted to ensure drainage & then the closure is completed. This is followed by adding a second suture layer. The closure line is tested to ensure water tightness. The stoma is then tested for fluid continence and ease of catheterization. On the outside and involving the skin, a stomal opening is created. The tapered ileum is then delivered through the opening and tacked to the rectus fascia and the skin edge. The stoma is then retested for continence and ease of catheterization.
This video shows the stepwise construction of the functional diversion system in a patient who had neurogenic bladder. Her postoperative course was uncomplicated and she is currently content with her quality of life.
Augmentation ceco-cystoplasty continent urinary diversion allows for improvement in quality of life of patients who are afflicted by urinary incontinence refractory of conventional management modalities.