Open bladder augmentation ileocystoplasty, appendicovesicostomy creation, and bladder neck reconstruction

Abstract

Introduction: Bladder augmentation with catheterizable channel creation is indicated for patients with neurogenic bladder (poorly complaint/high pressure) to preserve kidney function and provide long-term social continence when conservative medical management has failed. An open surgical approach is currently the gold standard. Methods: A 10-year-old-male with a history of neurogenic bladder due to sacral agenesis and caudal regression syndrome (wheelchair bound), solitary left kidney with worsening vesicoureteral reflux (grade 3), and continued daytime and nighttime incontinence underwent an open bladder augmentation ileocystoplasty, with creation of an appendicovesicostomy catheterizable channel, and bladder neck reconstruction. Results: Total operative time was 230 min. EBL was less than 50 cc. Patient was discharged on post-operative day 9. At the 6 month post-operative visit, patient is selfcatheterizing the APV channel every 2-3 h with daytime outputs of 300 mL-500 mL and nighttime output between 200 mL-300 mL. Renal ultrasound shows improved grade 3 hydronephrosis, with improved renal pelvis dilation and more robust appearing renal parenchyma. Conclusion: This video demonstrates the steps of an open bladder augmentation ileocystoplasty, with creation of an appendicovesicostomy catheterizable channel, and bladder neck reconstruction.

Keywords

• Bladder
• Augmentation
• Appendicovesicostomy
• Ileocystoplasty
• Bladder neck reconstruction
• Neurogenic bladder