The use of the cecum for cecocystoplasty.

Abstract

AbstractCystoplasty is a well‐established technique for the enlargement of a contracted bladder due to tuberculosis or interstitial cystitis. It may also be a practical alternative to urinary diversion for some bladder tumors and in carefully selected forms of neuropathic bladder.The choice of bowel segment used for bladder augmentation or substitution will depend largely on the personal preference of the individual surgeon, for no one segment is clearly any better than many others. My own preference is for the ileocecal segment because it gives a flexibility of reconstruction, particularly for replacing diseased ureters as well as the bladder. Apart from its suitable shape, it also has a good blood supply and relative freedom from compromising pathological conditions.The functional results of a supratrigonal cecocystoplasty are better than those of a subtotal or total cystectomy with ureteroileal cecocystoplasty because the lack of bladder sensation in these latter groups results in nocturnal incontinence. By voiding at suitable intervals, diurnal continence is often achieved.If incontinence becomes a serious problem, it may be corrected with either an artificial urethral sphincter or a colposuspension operation with intermittent self‐catheterization for any urinary retention.It is essential to follow these patients carefully, both clinically and radiologically, and with urodynamic studies. This gives the basis for logical pharmacological and endoscopic control of the voiding balance between bladder pressure and outflow resistance.