The incision for augmentation of the bladder and creation of a catheterizable channel is from the pubic bone to above the belly button (umbilicus).

Figure 1 – The incision for augmentation of the bladder and creation of a catheterizable channel is from the pubic bone to above the belly button (umbilicus).

The bladder is opened from front to back. This creates space for the bowel to be sewn in place and also acts to defunctionalize the bladder so it cannot spasm.

Figure 2 – The bladder is opened from front to back. This creates space for the bowel to be sewn in place and also acts to defunctionalize the bladder so it cannot spasm.

The cecum, ascending colon, and terminal ileum is isolated to create the bowel segment for augmentation of the bladder and creation of the catheterizable channel.

Figure 3 – The cecum, ascending colon, and terminal ileum is isolated to create the bowel segment for augmentation of the bladder and creation of the catheterizable channel.

The cecum, ascending colon and terminal ileum is detached from the bowel and the small bowel is reconnected to the large bowel.

Figure 4 – The cecum, ascending colon, and terminal ileum is detached from the bowel, and the small bowel is reconnected to the large bowel.

The large bowel is opened to use for augmentation and the terminal ileum is reduced and tightened to serve as the catheterizable channel.

Figure 5 – The large bowel is opened to use for augmentation and the terminal ileum is reduced and tightened to serve as the catheterizable channel.

Sewing the augmentation to the bladder to expand its volume.

Figure 6 – Sewing the augmentation to the bladder to expand its volume

After the augmentation of the bladder and creation of the catheterizable channel.

Figure 7 – After the augmentation of the bladder and creation of the catheterizable channel

Surgery: The cutaneous catheterizable ileocecocytoplasty is a surgery that we have found to be very successful here at University of Utah Health. In this surgery the bladder is expanded with large bowel from the cecum and ascending colon. The connection to the small bowel serves as the catheterizable channel, which comes up to the belly button. This small bowel (terminal ileum) is narrowed to about the diameter of a pencil. There is a natural valve (ileocecal valve) between the small bowel and large bowel that prevents leakage out of the channel. The surgery both increases the size of the bladder and creates a catheterizable channel when patients cannot easily catheterize the urethra.

What is involved in surgery?

The surgery takes about five to six hours to perform. Patients usually are in the hospital after surgery about seven to 14 days. The main thing that keeps them in the hospital is the return of the bowels to proper function. It takes a while for patients to begin to eat and have normal bowel movements after a piece of the bowel is used to reconstruct the bladder.

Patients then have a large suprapubic tube that drains the bladder while it heals. This stays in place for one month then patients begin to catheterize the bladder either via their urethra or from the catheterizable channel. The suprapubic tube is removed after patients are catheterizing successfully without problems, usually a couple of weeks later. At first patients catheterize frequently, but time is added in between catheterizations until they are catheterizing about four to five times in 24 hours.

What are some of the complications associated with the surgery?

There are some immediate complications from surgery that we watch for very closely. These are problems like:

  • Bowel obstruction,
  • Hernia,
  • Bowel or bladder fistula, and
  • Post-operative infections.

The long-term complications can be problems like leakage from the catheterizable channel or difficulty with catheterization. These problems occur in about 10 percent of patients, and these patients may need revision of their catheterizable channel.

What is the post-op recovery from the surgery?

Bladder augmentation surgery is large abdominal surgery, and it takes some time to recover. Patients need about six weeks until they begin to do their regular activities and may have some pain and healing that occurs up to three months after surgery. It is important to do no heavy lifting for about six weeks after surgery to prevent a hernia.