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Detubularisation in cystoplasty: clinical review
C Cheng1, W F Hendry, R S Kirby
1Department of Urology, St Bartholomew's Hospital, London.
British Journal of Urology
|March 1, 1991
Summary
Detubularised bowel segments are preferred for cystoplasty, reducing neobladder contractility but not eliminating it. Patients still face risks of incontinence and upper tract dysfunction following this bladder augmentation surgery.
Area of Science:
- Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Cystoplasty, a surgical procedure to augment or replace the bladder, often utilizes intestinal segments.
- Detubularisation of bowel segments is a technique aimed at improving the functional characteristics of the neobladder.
- Traditional tubularised bowel segments can lead to undesirable contractile properties and complications.
Purpose of the Study:
- To evaluate the functional outcomes and potential complications of cystoplasty using detubularised bowel segments.
- To compare the contractility of neobladders constructed from detubularised versus tubularised bowel.
- To assess the impact of detubularised cystoplasty on renal function and risk of obstruction.
Main Methods:
- Experimental studies comparing detubularised and tubularised intestinal segments for cystoplasty.
- Assessment of neobladder contractility post-surgery.
- Monitoring of renal function and incidence of upper tract dysfunction.
- Evaluation of incontinence rates, particularly nocturnal incontinence.
- Analysis of risks for upper tract obstruction.
Main Results:
- Detubularised bowel segments lead to reduced neobladder contractility compared to tubularised segments.
- Neobladder contractions are not completely abolished, and incontinence, especially nocturnal, can persist.
- A significant incidence of upper tract dysfunction has been observed despite detubularisation.
- All patients undergoing cystoplasty remain at risk of upper tract obstruction.
Conclusions:
- Detubularised bowel segments represent an improvement over tubularised segments in cystoplasty, primarily by reducing neobladder contractility.
- Strategies to manage bladder volume, such as clean intermittent self-catheterisation, may help mitigate contractions.
- Close monitoring for upper tract dysfunction and obstruction is crucial in patients following cystoplasty.
- Sphincter rebalancing may be necessary in conjunction with cystoplasty to address incontinence effectively.