Application of Appendicular-Based Cecal Flap for Less Invasive Augmentation Cystoplasty: A Novel Technique

Abstract

Objectives: To evaluate the use of a new modified technique for augmentation cystoplasty on selected cases, both in terms of improvements in bladder urodynamics and creating an ideal conduit for clean intermittent catheterization. Methods: Ten patients suffering from intractable low-compliance bladder and reasonable capacity underwent appendicular-based cecal flap augmentation cystoplasty. The procedure comprised the isolation of a 10 to 12 × 3 to 5-cm cecal flap on the base of the appendicular pedicle, by which the bladder was augmented and the appendix was brought out through the abdominal wall for catheterization. Without any bowel anastomosis, the cecal anterior wall was repaired. Results: After a mean follow-up of 23.8 months, 9 of 10 patients became continent. Postoperative urodynamic study revealed a 53.8% increase in mean maximal cystometric capacity (from 171.4 to 263.7 ml; p = 0.012) and a 7.7-fold increase in mean bladder compliance (from 3.39 to 26.66 ml/cm H₂O; p = 0.012). Mean maximal detrusor filling pressure decreased by 79% (from 62.2 to 13 cm H₂O; p = 0.012). Renal function remained stable in all patients. Appendicular stoma was easy to catheterize, and no stomal stenosis occurred during the follow-up period. Conclusions: Early results of this less invasive technique could be promising in patients with high filling pressure and acceptable maximum bladder capacity.

The past, present and future of augmentation cystoplasty

“…It has great mobility, which permits tension‐free ureteric anastomosis; however, the diarrhoea and malabsorption associated with resection of the ileo‐caecal valve is often significant [59], and it is common to avoid this segment for bladder augmentation if possible. The use of the appendicular‐based caecal flap has been described favourably as a ‘less invasive’ technique for augmenting bladder [60].…”

In situ Reversed Ileocystoplasty for Less Invasive Augmentation Cystoplasty: An Experimental Study

“…In the era that enterocystoplasty is considered as a standard procedure for bladder augmentation in patients with low compliant bladder with failed conservative management, concerns about the potential complications of this procedure such as electrolyte imbalance, mucous production and persistent bacteruria owing to direct contact of the urine with intestinal mucosa led to the ongoing experimental trials in an attempt to introduce alternative techniques [10] . The use of de-epithelialized intestinal patch has been well studied both clinically and experimentally.…”