Cutaneous Catheterizable Ileocecocystoplasty

What Is Cutaneous Catheterizable Ileocecocystoplasty?

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.

Surgical Procedure

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.

An anatomical illustration of the human digestive system showing the intestines and stomach. — 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).

Illustration depicting a surgical procedure showing the anatomy and instruments used during the operation. — 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.

Illustration showing a surgical procedure with hands manipulating part of the intestine — 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.

Illustration of a surgical procedure involving the intestines with a clinician's hands manipulating the tissue. — Figure 4 – The cecum, ascending colon, and terminal ileum is detached from the bowel, and the small bowel is reconnected to the large bowel.

An illustration depicting a catheter being inserted into a human organ. — 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.

Illustration showing an organ with connected surgical instruments and sutures. — Figure 6 – Sewing the augmentation to the bladder to expand its volume

Illustration of the human digestive system including the stomach and intestines. — Figure 7 – After the augmentation of the bladder and creation of the catheterizable channel

Possible Complications

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.

Surgical Recovery

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.