Results

From 1999 to 2001, we performed laparoscopic enterocystoplasty in 18 patients with functionally reduced bladder capacities owing to neurogenic causes (Table 1). The procedures included ileocystoplasty (5), sigmoidocystoplasty (3), colocystoplasty (1),

FIGURE 7 ■ Augmentation cecocystoplasty with formation of a continent catheterizable stoma. Complete view of the bowel to bladder anastomosis (A) in preparation for maturation of the catheterizable stoma to the umbilicus (B). Source: Courtesy of the Cleveland Clinic Foundation.

and cecocolocystoplasty with a continent catheterizable ileal stoma (9). Total surgical time from patient arrival to the OR until transportation to the recovery room ranged from 5.3 to 8 hours (average 7.0 hours). The time for laparoscopic suturing ranged from 1.7 to 3.1 hours (average 2.4 hours). Blood loss was minimal and did not exceed 250 mL in any of the cases (average 175 mL). The only intraoperative complication was a trocar-induced rectus sheath hematoma during the course of the sigmoidocystoplasty that was controlled laparoscopically. Oral feeding was resumed by 24 hours in 17 of 18 patients. Our first patient had a self-limited paralytic ileus that responded to conservative treatment. Despite the fact that most of the patients in this initial experience had moderate to severe forms of neurological dysfunction owing to multiple sclerosis, the average hospital stay until the patient was discharged home was only 5.7 days (range 3-7). Most

TABLE 1 ■ Laparoscopic Enterocystoplasty Experience

ID

Age (yrs)

Gender

Primary disease

OR time (hrs)

Blood loss

Hospital

Bowel segment Isolated

1

27

M

SUS

6

300

10

Ileum

2

49

F

MS

7

350

9

Sigmoid colon

3

30

F

SCI

7

200

5

Cecum and right colon and ileum

4

48

F

TM

3

60

6

lleum

5

36

F

MS

8

150

6

Cecum and right colon and ileum

6

62

MS

5

300

4

lleum

7

18

F

SCI

8

110

6

Cecum and right colon and ileum

8

46

F

MS

8

125

6

Cecum and right colon and ileum

9

52

F

MS

5

200

5

Sigmoid colon

10

23

F

SB

8

200

6

Rectal colon

11

38

F

MS

7

350

7

Cecum and right colon and ileum

12

45

F

SCI

9

550 l

5

Cecum and right colon and ileum

13

31

F

SCI

9

300

4

Cecum and right colon and ileum

14

58

F

MS

4

150

4

Ileum

15

27

F

SCI

7

200

3

Sigmoid colon

16

39

MS

8

200

4

Cecum and right colon and ileum

17

49

F

DI

8

200

3

Ileum

18

42

F

MS

6

100

5

Cecum amd right colon and ileum

Abbreviations: OR, Operating room; SUS, sensory urgency syndrome; MS, multiple sclerosis; SCI, spinal cord injury; SB, spina bifida; D, detrusor overactivity.

notable was the absence of long-term or extended care needs for the patients with multiple sclerosis because of demands of wound healing or functional neurological loss that typically occur with an open procedure in this subset of patients.

All patients have been evaluated with preoperative and postoperative questionnaires concerning bladder (bladder control scale; BLCS) and bowel control (bowel control scale; BWCS). Fourteen patients [2 (14.4%) male and 12 (85.6%) female; mean age, 40 years (range 18-62)] have completed at least the sixth month postoperative questionnaires based on a mean follow-up of 17 months (range, 7-27). With regard to the quality of life measure using the BLCS, there was significant clinical improvement. The average improvement revealed a significant reduction from the baseline score of 14.9 + 5.0 to 1.6 + 1.8, P = 0.0002. In regards to the potential risk of causing bowel dysfunction by harvesting various bowel segments for augmentation cystoplasty, there was no clinically significant difference in the bowel control score before or after the procedure when comparing the average change from 6.4 + 6.5 to 5.3 + 6.0, P = 0.30.

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