Laparoscopic Bladder Augmentation With And Without Urinary Diversion

Raymond R. Rackley and Joseph B. Abdelmalak

Section of Voiding Dysfunction and Female Urology, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

INTRODUCTION

Enterovesical Anastomosis

PATIENT SELECTION: INDICATIONS AND

Postoperative Management

CONTRAINDICATIONS

Results

PREOPERATIVE PREPARATION

Comparative Analysis of Open and

SURGICAL TECHNICAL STEPS

Laparascopic Approaches

Port Placement

Laparascopic Ileovesicostomy and

Selection and Mobilization of the Bowel

Augmentation

Segment

Surgical Technique

Exclusion and Re-Anastomosis of the Bowel

■ RESULTS

Refashioning of the Isolated Bowel Segment

■ SUMMARY

Bladder Mobilization and Cystotomy

■ REFERENCES

Augmentation cystoplasty remains the most widely accepted reconstructive technique for creating a compliant, large capacity bladder that protects the upper urinary tract and provides urinary continence in people with bladder dysfunction secondary to noncompliance or reduced functional capacity.

Enterocystoplasty effectively provides a durable increase in bladder capacity and compliance; however, the morbidity and postoperative discomfort associated with the open laparotomy incision are major deterrents.

The use of laparoscopic techniques in reconstruction has been limited because of the technical complexity of the procedures involved. The technical steps in performing a laparoscopic bladder augmentation are designed to emulate the open surgical counterpart in every aspect, thereby producing similar functional results with improved recovery.

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