Augmentation Cystoplasty

[mark3w]

I am a 55 year old male and an incomplete T-6 paraplegic with additional total crushing of L-4/5 & S-1 with corresponding Cauda Equina Syndrome who has had an indwelling suprapubic catheter in place for 10 years. Because of recurrent UTI problems it is now being suggested that I undergo the Augmentation Cystoplasty. What frightens me most is the use of a portion of the bowel to do this surgery because throughout the 14 years since my injury I have been able to maintain bowel function. The bacteria infecting the bladder are now at a point of being drug resistant to all but a small handful of IV antibiotics, so I understand the reasoning I'm being given. (Bacteria involved are, Pseudomonas Aeruginosa & Enterococcus Faecali both with colony counts > 100,000 COL/ML.)

Since I have no feeling below mid chest, how am I going to know when the bladder needs draining, is there apt to be leakage from the stoma particularly at night? What is the likelihood that this surgery will eliminate the constant bladder infection?

Finally, I guess I’d kind of like some feedback from others who have had this type of surgery if that’s allowed. What if any problems are typical post surgically, and I'm looking for validation of what the Veterans Administration Doctors are saying.

Mark

[Kevin Pho, MD]

There is no guarantee the the cystoplasty would eliminate the chronic bladder infection.  Possible complications include the usual complications resulting from a major abdominal surgery, bowel obstruction, blood clots, infection, and pneumonia. Also, there is a risk of developing urinary fistulae (abnormal tubelike passage into the genitourinary tract) , urinary tract infection, difficulty urinating, and a rare possibility of increased risk of developing tumors.



The following are results from a study showing complications from a patient's perspective for the surgery, suggesting a high degree of patient satisfaction:



"The patients experienced a significant increase in bladder capacity and decrease in pressure at capacity (P < 0.0001). Normal upper tracts remained normal and there was either improvement or stabilization of hydronephrosis. Twenty-four patients (40.6%) had one or more complications, with 21 requiring reinterventions. Twenty-five percent of patients required the reintervention within the first 25 months, and the median time to reintervention was almost 10 years. Thirty-five patients took medications such as anticholinergics, antidiarrheals, or antibiotics. Fifty-six patients were treated with clean intermittent catheterization (CIC) at a mean interval of 4.6 hours. Seven patients had some difficulty with CIC. Thirty-nine patients (67%) were dry, and 17 had mild and 3 severe incontinence. Eleven patients (18.6%) reported bowel dysfunction, although 7 had it preoperatively. Almost all patients were very satisfied with their urologic management."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=98434056



I am not a urologist and do not know how leakage can be detected in paraplegic patients.



You may want to obtain a second urological opinion.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

Medical Weblog:

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[mark3w]

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