Patient Selection Indications And Contraindications

The goal of augmentation cystoplasty is to restore the compliant storage properties of the urinary bladder. Noncompliant, small capacity bladders that typically do not respond to more conservative forms of treatment can be surgically augmented. Interruption of the bladder innervation and musculature with the use of detubularized bowel to augment the resultant defect may decrease efficiency of the spontaneous voiding mechanism. People with neurogenic bladder dysfunction will generally require clean intermittent catheterization for prolonged or indefinite periods postoperatively to empty the bladder effectively. In addition, the physical disabilities or limitations due to neurologic conditions may prevent one's ability to catheterize via the urethra; thus, a continent catheterizable abdominal stoma should be considered in addition to bladder augmentation.

A relative contraindication specific to laparoscopic bladder augmentation is the presence of extensive intra-abdominal and pelvic adhesions that would preclude a laparoscopic bowel dissection.

Our experience in open and laparoscopic approaches for this procedure suggests that people with ventriculoperitoneal shunts typically have increased abdominal adhesions that may preclude a successful laparoscopic approach. Routine laboratory studies include renal function and serum electrolytes, whole blood cell count, urinalysis, and when appropriate, a urine culture. Upper and lower urinary tract studies are important baseline evaluations. A urodynamic study and cystoscopy will provide additional useful information about the competence of the urinary sphincter and pre-existing bladder pathologies.

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