51960 Enterocystoplasty, including intestinal anastomosis

Name of the Procedure:

Enterocystoplasty (Bladder Augmentation or Augmentation Cystoplasty)

Summary

Enterocystoplasty is a surgical procedure that increases the size of the bladder using a segment of the intestine. This is done to help the bladder hold more urine and function more effectively.

Purpose

Enterocystoplasty addresses issues with bladder function, such as severe incontinence or reduced bladder capacity. The goal is to improve the patient's quality of life by increasing bladder volume and reducing symptoms of bladder dysfunction.

Indications

• Severe urinary incontinence
• Small bladder capacity due to congenital conditions (e.g., spina bifida) or after surgeries
• Bladder damage from radiation or chronic infections
• Overactive bladder unresponsive to other treatments

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medications may need to be adjusted or stopped as advised by the physician.
• Pre-op tests may include a urinalysis, blood tests, imaging studies, and urodynamic tests to assess bladder function.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the bladder.
3. A section of the intestine (usually ileum or sigmoid colon) is isolated and removed.
4. The isolated intestinal segment is reshaped and sutured to the bladder, creating an expanded bladder reservoir.
5. Both the bladder and intestine are closed, ensuring all anastomoses (connections between the intestine and bladder) are secure.
6. The abdominal incision is closed with sutures.

Duration

The procedure usually takes about 4-6 hours.

Setting

Performed in a hospital's surgical suite.

Personnel

• Surgeon (usually a urologist with experience in reconstructive surgery)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Bowel obstruction
• Urinary tract infections
• Metabolic disturbances due to absorption of urine by the intestinal segment
• Urinary fistula (abnormal connection between urinary tract and another organ)

Benefits

• Increased bladder capacity
• Reduced frequency and urgency of urination
• Improved urinary continence
• Enhanced overall bladder function

Recovery

• Hospital stay of 7-10 days
• Catheterization to drain urine for several weeks
• Pain management typically involves medications
• Avoid heavy lifting and strenuous activities for 6-8 weeks
• Follow-up appointments for monitoring and possible adjustments to catheter care or medications

Alternatives

• Intermittent catheterization
• Anticholinergic medications to manage bladder spasms
• Sacral nerve modulation or other neuromodulation therapies
• Botulinum toxin (Botox) injections into the bladder muscle

Patient Experience

• Patients will likely feel soreness and tenderness at the incision site.
• Pain and discomfort can be managed with medications.
• Gradual return to normal activities, with careful adherence to post-operative instructions, is expected.
• Some patients may need to adapt to a new regimen of intermittent self-catheterization, depending on the specific details of their surgery and healing process.