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The first 25 slides, exactly as they appear. The full deck has 81 content slides.
Paediatric Surgery
Augmentation Cystoplasty
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 81 slides
The Problem and the Idea
Why we rebuild a bladder from bowel
- What is augmentation cystoplasty?
- Why low pressure is the whole point
- A 130-year-old idea
- The breakthrough that made it practical: CIC
- Which children need it
- The core rationale in one sentence
- Augmentation at a glance
Physiology and Selection
Deciding who truly needs surgery
- What good urinary storage needs
- Estimating expected bladder capacity: the Koff formula
- A refinement: the Kaefer formulas
- Compliance - the key concept
- The 40 cm H2O danger line
- Try medicines first
- What botulinum toxin can and cannot do
- When augmentation becomes the option
- A special setting: renal transplantation
- Success depends on the family, not just the surgeon
- Working up the patient: imaging
- Working up the patient: urodynamics
- Planning the catheterization route and approach
- Getting ready for theatre
Choosing the Tissue
Every segment of gut behaves differently
- The menu of donor tissues
- Gastric (stomach) tissue
- The catch with stomach: it keeps secreting acid
- Small and large intestine: the workhorses
- Why bowel causes metabolic trouble
- Surgical downsides of bowel augmentation
- Ileum vs sigmoid: an unsettled debate
Ileocystoplasty Step by Step
From incision to catheterizable stoma
- Opening and exposing the bladder
- Abdominal opening and bladder dissection
- Opening the bladder like a clam
- Circumferential opening of the bladder
- Harvesting and opening the ileal segment
- Isolating and opening the ileal segment
- Sewing the patch into the bladder
- Anastomosing the ileal patch to the bladder
- Need more volume? Fold the bowel
- U-folded ileal segment for extra capacity
- Adding a catheterizable channel: the Mitrofanoff
- Isolating the appendix for a Mitrofanoff channel
- Building the appendicovesicostomy (intravesical)
- Appendicovesicostomy: intravesical approach
- Closing the augmented bladder
- Closing the augmented bladder
- An alternative: extravesical appendicovesicostomy
- Appendicovesicostomy: extravesical approach
- Bringing the stoma to the skin
- Cutaneous appendicovesicostomy stoma
- After the operation: catheter management
- Why the ileum still upsets the chemistry
- Infection control in the augmented bladder
- Sigmoid cystoplasty
Long-Term Complications
The price of putting bowel in the bladder
- Bladder perforation - rare but deadly
- What the big series tell us about perforation
- Perforation: the shunt danger and management
- Stone formation
- What augmentation stones are made of
- Neoplasia - the long-shadow risk
- The evidence and the surveillance plan
Alternatives to Bowel
Trying to avoid intestine altogether
- Ureterocystoplasty - using the patient's own ureter
- Ureterocystoplasty - more evidence
- Demucosalized enterocystoplasty
- Autoaugmentation - no new tissue at all
- Autoaugmentation - why enthusiasm cooled
Tissue Engineering and the Future
Growing a bladder instead of borrowing bowel
- Why engineer new tissue?
- Two engineering strategies
- SIS and the hard lesson of long-term results
- The Atala milestone - engineered bladders in humans
- Conclusions and future directions
- Numbers worth remembering
- References (1/2)
- References (2/2)
- Pediatric Surgery and Pediatric Urology