Treatment of Bladder Injury: Reconstructive Surgery Using Extraurinary Autologous Tissues

Abstract

Unlike the ureter and the urethra, one particularity of the bladder function is its full dependence on sympathetic, parasympathetic, and somatic nerve supplies integrity. The bladder often suffers from spine, sacral plexus, or pelvic nerves injuries, and its dysfunction represents a direct threat to the kidneys. There are multiple reconstructive techniques that the human genius has invented to alleviate neurogenic cystopathy or to palliate a congenital abnormality or a cystectomy performed for various reasons such as muscle-invasive bladder cancer. With the exception of a cutaneous urostomy, they all use bowel segments (mostly the terminal ileum) with their intact mesenteries to refashion the bladder, augment its capacity, or just drain out the urine through the abdominal wall. Although this topic deviates somehow from the subject treated in this book, as the underlying problem is mainly a congenital, neurological, or oncological pathology, a succinct overview of the techniques alluded to above would not be superfluous. Indeed, the following case report would solely justify this additional effort: inadvertent cystectomy has occurred during a cesarian section complicated with severe hematuria necessitating urgent hysterectomy [1]. The entire body of the bladder and lower ureters were removed along with the uterus leaving only the bladder neck and part of the trigone. The management included immediate cutaneous ureterostomy and elective bladder augmentation with a catheterizable continent stoma using the appendix.