augmentation cystoplasty

I am seeking help deciding whether or not to undergo augmentation cystoplasty which has been recommended for me by a urologist. Following the preop. workup 6 days prior to the scheduled date of surgery, the anesthesiologist requested a more thorough cardiac evalution before proceeding with the operation citing the following: 1. complicated medical history - i.e. 68 yr old paraplegic (14 yrs) due to subarachnoid hemorrhage at T10 (AV anomaly); 2. MI secondary to the bleed; 3. Code Blue incident due to anaphylactic shock (IVP dye); 4. hypertension (currently); and  4. the stress of a procedure requiring at least 4 hrs under anesthesia.  My questions are: 1. Do the risks of the operation and postop long term complications outweight the risks of conservative treatment with anticholinergics and CIC? (Intrabladder pressures are presently quite high but kidney function appears to be normal.) 2. Is there research that discloses the quality of life and average life span following augmentation cystoplasty? 3. Likewise, what is the average life span after kidney damage sets in due to repeated bladder infections and constant high bladder pressures? 4. What course of treatment in such situations is being followed in other medical centers and with what degree of success?  5. Is research available comparing the outcome of the various methods of management?  Thank you for your response!

[HFHS M.D.-BE]

Dear Virginia,
There are a lot of questions here that are best answered by your urologist, since he has the benefit of all the medical issues and comorbidities specifically for you. I will try and answer your questions as best as possible.
Aside from the usual potential complications such as infection, bleeding, bowel problems, etc., following this kind of surgery, the patients usually do well, with better quality of life and better maintenance of renal function after the cystoplasty. In your particular case I can not be certain as to how much risk you may have, not having the benefit of the full medical history. This is up to your doctors to decide, and for you to see how much benefit you may get from this vs. continuing with CIC and anticholinergics. You may have to talk to some patients who have had augmentation cystoplasty, in order to get a first hand view of its pros and cons. The average life span, following this procedure, barring any immediate post operative morbidity and mortality, should be as well or better than matched controls, since the procedure would presumably help restore or maintain renal function. This is by virtue of decreasing episodes of kidney infections, and decreasing the bladder pressure both of which help with better kidney health.
The life span is certainly compromised in patients with deteriorating kidney function, infection and high blood pressure. The degree of compromise is dependent on each patient

[judith]

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[JENNY]

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