Ureterocystoplasty (bladder augmentation) with a solitary kidney

Case report: The theory of post-ileocystoplasty spherical configuration in patients with low-capacity bladder

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Detubularization form offers greater volume and lower pressure in the reservoir to augment the bladder.

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Patients with low-capacity bladder who have poor compliance with ureteral involvement have poor renal function.

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Low compliance bladder will cause numerous symptom such which will lead to insufficient bladder emptying.

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Bladder augmentation is a management option for neurogenic and non-neurogenic bladder dysfunction when conservative management, medical pharmacological therapy and minimally invasive management have not yielded satisfactory results.

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The aim of doing bladder augmentation is to create a reservoir with adequate functional capacity and low bladder filling pressure so that low intravesical pressure will not interfere with the flow of urine from the bladder to the urethra.

Introduction

Bladder augmentation can be performed by detubularization of the small or large intestine. A large capacity bladder is necessary to avoid frequent urination; thus, the ileal sac must be able to store the maximum volume of urine with relatively low pressure and the shortest length of the intestine. The acceptable pressure capacity should always be under ureteric pressure to avoid back pressure and kidney damage. Large capacity at low pressure is referred to as good compliance. Desirable preparations for augmentation, which is the use of the shortest length of the intestine, reduce the chance of diarrhea and vitamin deficiency and retain the intestines which may be required for augmentation.

Aim

Clinical and urodynamic evaluation of the recent postoperative condition of the patient who underwent ileocystoplasty, confirmed by the theory of detubularization (spherical) configuration.

Case presentation

Patient with complaints of frequent urination and small amount of urine. Ultrasound examination showed low volume bladder capacity and bilateral hydronephrosis and hydroureter. From cystography and VCUG examination, low capacity bladder, grade 1 VUR on the right side, grade 4 VUR on the left side accompanied by bilateral hydronephrosis and hydroureter. The patient has a history of right nephrectomy in 2014 for pyonephrosis due to kidney stones. The patient was then subjected to bladder augmentation using a segment of the ileum (ileocystoplasty) in 2015. In the postoperative evaluation, clinical symptoms, radiological and uroflowmetric examinations were evaluated.

Conclusion

The detubularization form offers greater volume and lower pressure in the reservoir to augment the bladder.