Successful Augmentation Ileocystoplasty for Urinary Incontinence in a 25 Y.O. Male
PACE Hospitals
PACE Hospitals’ expert Urology team successfully performed Augmentation Ileocystoplasty with Bladder Neck Repair and Appendicular Mitrofanoff Creation on a 25-year-old male patient with urinary incontinence and a small-capacity bladder. The procedures aimed to increase bladder capacity, improve urinary continence and bladder emptying, create a reliable catheterisable channel, and improve the patient’s overall quality of life.
Chief Complaints
A 25-year-old male patient with a body mass index (BMI) of 19 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of urinary incontinence and severe storage lower urinary tract symptoms.
Past Medical History
The patient had undergone surgical correction for bladder exstrophy at the age of 1 year. He had no known drug allergies and no other significant medical conditions present.
On Examination
On examination, the patient was conscious, coherent, and clinically stable. A detailed urological evaluation was performed to assess urinary leakage, bladder function, urethral narrowing, and bladder capacity. No other significant abnormalities were noted.
Diagnosis
Upon admission to PACE Hospitals, the patient was evaluated by the Urology team through a detailed review of his symptoms, past surgical history, and clinical examination. He presented with urinary incontinence and severe storage lower urinary tract symptoms, with a history of bladder exstrophy repair during childhood.
A urodynamic study was performed to assess bladder storage and urinary control. The study showed urinary leakage at low bladder filling volumes, indicating poor bladder capacity and impaired continence.
Based on the clinical assessment and diagnostic findings, the patient was advised to undergo Urinary Incontinence Treatment in Hyderabad, India, under the care of the Urology Department at PACE Hospitals.
Medical Decision Making (MDM)
After a detailed consultation with Dr. Abhik Debnath (Consultant Laparoscopic Urologist), the patient underwent a comprehensive evaluation for urinary incontinence and severe storage lower urinary tract symptoms. His previous history of bladder exstrophy repair during childhood was reviewed, and a urodynamic study demonstrated urinary leakage at low bladder filling volumes, indicating poor bladder capacity and impaired urinary continence.
Based on the clinical findings, the patient was diagnosed with a small-capacity bladder, open bladder neck, narrow urethra, and urinary incontinence.
Considering the severity of symptoms and the underlying structural and functional abnormalities, it was determined that augmentation ileocystoplasty with bladder neck repair and appendicular Mitrofanoff creation was the most appropriate treatment to increase bladder capacity, improve urinary control, and provide a reliable route for intermittent catheterisation.
The patient and his family were informed about the diagnosis, planned procedures, expected benefits, possible risks, postoperative catheter care, and the need for long-term follow-up. Informed consent was obtained before proceeding with surgery.
Surgical Procedure
Following the decision, the patient was scheduled to undergo Augmentation Ileocystoplasty in Hyderabad at PACE Hospitals with bladder neck repair and appendicular mitrofanoff creation under the care of the Urology Department.
The procedure involved the following stages:
- Patient Preparation and Anaesthesia: After completing the required preoperative investigations and anaesthesia assessment, the patient was prepared for surgery. The procedures were performed under general anaesthesia after obtaining informed consent.
- Cystoscopic Evaluation: Cystoscopy was initially performed to examine the urethra, bladder neck, and urinary bladder. This helped the Urology team assess the narrow urethra, open bladder neck, and small bladder capacity before definitive reconstruction.
- Augmentation Ileocystoplasty: A segment of the ileum was used to enlarge the urinary bladder. This procedure was performed to increase bladder capacity, improve urine storage, and reduce leakage caused by the small-capacity bladder.
- Bladder Neck Repair: The bladder neck was surgically repaired to improve the outlet resistance and support better urinary continence. This step aimed to reduce involuntary urine leakage associated with the open bladder neck.
- Appendicular Mitrofanoff Creation: A continent catheterisable channel was created using the appendix to connect the bladder to the abdominal skin. This channel allows the bladder to be emptied using intermittent catheterisation while helping prevent continuous urine leakage.
- Completion of the Procedure: After ensuring satisfactory reconstruction and haemostasis, the necessary urinary catheters and drains were placed for postoperative drainage and healing.
Postoperative Care
The postoperative period was uneventful, and the patient remained hemodynamically stable throughout the hospital stay. Bladder saline washes were started from postoperative day 4. The per-urethral Foley catheter was removed on postoperative day 6, followed by removal of the ureteric catheters and wound staples on postoperative day 12. The surgical drain was removed on postoperative day 14.
The patient received medications to prevent postoperative infection, relieve pain, control fever, improve bladder function, protect the stomach, reduce urinary discomfort, support recovery and wound healing, and promote overall postoperative recovery.
Discharge Medications
At discharge, the patient was prescribed medications to prevent infection, pain relief, support bladder function, gastric protection, multivitamins, alkalising agents, and other supportive medications. He was advised to continue the prescribed medications as directed by the treating urologist. The patient was discharged in a hemodynamically stable condition with the suprapubic catheter and Mitrofanoff tube in situ.
Advice on Discharge
The patient was advised to continue a high-protein diet, maintain adequate hydration by drinking plenty of fluids (approximately 4 litres per day), continue routine medications, and follow the instructions provided for catheter care until the scheduled follow-up.
Emergency Care
The patient was advised to contact the emergency ward at PACE Hospitals in case of development of symptoms such as fever, abdominal pain, vomiting, difficulty in draining urine through the catheter or Mitrofanoff channel, excessive urine leakage, or any other concerning symptoms.
Review and Follow-up Notes
The patient was advised to return for a follow-up consultation with the Urologist in Hyderabad at PACE Hospitals after 1 week.
Conclusion
This case highlights the successful management of urinary incontinence, severe storage lower urinary tract symptoms, a narrow urethra, an open bladder neck, and a small-capacity bladder following previous bladder exstrophy repair. The patient underwent augmentation ileocystoplasty, bladder neck repair, and appendicular Mitrofanoff creation. The postoperative recovery was uneventful, and the patient was discharged in a hemodynamically stable condition with appropriate postoperative care, catheter management instructions, dietary advice, and scheduled follow-up.
Importance of Augmentation Ileocystoplasty in Small-Capacity Bladder
A small-capacity bladder can lead to urinary incontinence, frequent urination, and poor bladder storage, significantly affecting a patient's daily life. Augmentation ileocystoplasty is a reconstructive procedure that enlarges the bladder using a segment of the intestine, allowing it to store urine more effectively at lower pressure. When combined with bladder neck repair and appropriate urinary diversion techniques, it can improve continence, protect the upper urinary tract, and enhance the patient's quality of life. Long-term follow-up with a urologist/urology doctor is important to monitor bladder function and overall recovery.
Frequently Asked Questions (FAQs)
What is a small-capacity bladder?
A small-capacity bladder is a condition where the bladder holds significantly less urine than normal. This may cause frequent urination, sudden urgency, urine leakage, and discomfort as the bladder fills. Treatment depends on the cause and severity of the symptoms.
What causes urinary incontinence after bladder exstrophy repair?
Urinary incontinence may continue after bladder exstrophy repair if the bladder remains small, the bladder neck does not close properly, or the urinary muscles do not function normally. Previous surgery and changes in the urinary tract can also affect bladder control.
Why can bladder exstrophy cause urinary problems later in life?
Bladder exstrophy is a congenital condition that affects the bladder, bladder neck, urethra, and surrounding tissues. Even after childhood repair, some patients may later develop reduced bladder capacity, urinary leakage, difficulty emptying the bladder, or recurrent urinary infections.
What is a urodynamic study, and why is it performed?
A urodynamic study checks how well the bladder stores and empties urine. It measures bladder capacity, pressure, urine flow, and leakage. The results help the urologist understand the cause of urinary symptoms and plan the most suitable treatment.
What is augmentation ileocystoplasty?
Augmentation ileocystoplasty is a reconstructive surgery used to enlarge a small or poorly functioning bladder. A short segment of the small intestine is joined to the bladder, allowing it to store more urine at a lower pressure.
Can reconstructive bladder surgery reduce urinary leakage?
Yes, reconstructive bladder surgery can improve bladder capacity and urinary control in suitable patients. Procedures such as bladder augmentation, bladder neck repair, and Mitrofanoff creation may reduce leakage and support safer, more reliable bladder emptying.
What are the possible complications of augmentation ileocystoplasty?
Possible complications include urinary infection, mucus accumulation, bladder stones, leakage from the surgical site, bowel-related problems, difficulty with catheterisation, and changes in body salts. Regular follow-up helps detect and manage these concerns early.
What warning symptoms require emergency medical care after surgery?
Patients should seek immediate medical attention for fever, severe or increasing abdominal pain, repeated vomiting, reduced or absent urine drainage, catheter blockage, heavy bleeding, wound discharge, increasing swelling, or sudden worsening of urinary symptoms.
Can mucus collect in the bladder after augmentation ileocystoplasty?
Yes. The intestinal segment used to enlarge the bladder naturally produces mucus. This mucus can collect in the bladder and may block a catheter or contribute to infection or stone formation. Regular bladder irrigation may be advised to clear it.
Does bladder reconstruction protect kidney function?
Bladder reconstruction can help protect kidney function by improving urine storage at a lower pressure and supporting proper bladder drainage. However, patients still require regular follow-up to monitor bladder function, kidney function, urinary infections, and catheter care.
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