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Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
Question Title: Urinary Diversion for SCI (spinal Cord injured)Forum: The Urology Forum
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| Please supply some information on this procedure. I am a T5-6 complete paraplegic since 1980 and my urethra has pretty much given out after all these years of doing intermittant catheterizations and UTI's every other week. One Urologist suggested taking a muscle from my leg, to rebuild the urethra, but on a second opinion he suggested an augmentation (making the bladder larger). I do not require that, but the idea of closing off my urethra and re- routing it out my belly button, makes a lot of sense. I am calling this procedure a urinary diversion. Since I will then be using a catheter, placed in the bellybutton to empty the bladder, no bag/ostomy is required. He said that if my oppendix was in good shape it would be used otherwise they would need a piece of my bowel. My question is 1) is this good idea? 2) what is the recovery time? 3) are there any drawbacks I should be aware of 4) are there any questions, that I should be asking my doctor/urologist
____ Dear Pattid, Using the appendix(appendicovesicostomy)to empty the urine from the bladder is performed commonly(Mitrofanoff principle) particularly in children with Spinal Cord Diseases. I agree that this type of diversion is better than rebuilding the urethra or leaving a long-term foley catheter. If you are comfortable with Clean Intermittent Catheterization which it sounds like you are, than this is a very appropriate option for you. I would caution you to have your bladder fully worked-up before having the surgery. If you do need a bladder augmentation, your Urologist can perform both procedures at the same time. Another common complication of this procedure is stomal strictures with the inability to catheterize the bladder thus requiring modification or revision of the stoma at the umbilicus. Most surgeons will leave a foley catheter in the stoma for 10-days to two weeks to give the stoma a chance to heal. The bladder closure should result in immediate continence which is something I’m sure you desire. Remember this is abdominal/bowel surgery and you will require a few days to allow your bowels to recover in the hospital. If bowel is used for an augmentation, you may also need to irrigate the bladder periodically because of mucus build-up. Overall, I think your doctors have proposed a reasonable solution to your incontinence. It sounds like you are enthusiastic but cautious as you should be. I would however make sure that you don’t need an augmentation before you go ahead with the appendicovesicostomy, because you would hate to have two procedures when you could have had just one. This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568). Sincerely,
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