Bladder Reconstruction
Reconstructive surgery of the lower urinary reservoir and outlet: augmentation for the hostile low-capacity bladder, salvage of bladder-neck contracture and vesicourethral stenosis, and outlet / continence procedures used when the bladder can be saved but the outlet cannot be trusted.
General Principles
- Principles of Bladder AugmentationReservoir physics, safe storage pressure, Laplace's law, detubularization, bladder bivalving, bowel-segment selection, and the design logic behind modern augmentation.
- Principles of Bladder Neck ReconstructionOutlet resistance, lengthening-narrowing-tightening, flap-valve design, reservoir prerequisites, tissue quality, CIC planning, and salvage closure.
- Principles of Continent Catheterizable ChannelsMitrofanoff flap-valve design, tunnel length, implantation methods, conduit hierarchy, stomal construction, and long-term maintenance.
24 of 24 techniques
| Technique | Domain | Notes |
|---|---|---|
| Augmentation Cystoplasty | Capacity / Reservoir | Gold-standard reservoir salvage for refractory low-capacity or poorly compliant bladder. Usually detubularized ileocystoplasty; improves capacity, compliance, continence, and upper-tract safety when conservative therapy fails. |
| Ileocystoplasty | Capacity / Reservoir | Standard detubularized ileal augmentation and the modern default bowel-based reservoir expansion. Listed separately here because many series and operative discussions use the segment-specific name rather than the broader augmentation label. |
| Ileocecal Cystoplasty | Capacity / Reservoir | Ileocecal augmentation variant used when ureteral reach or implantation geometry favors the cecal segment. Included because some databases list it separately from generic enterocystoplasty. |
| Sigmoid Cystoplasty | Capacity / Reservoir | Colonic augmentation alternative when sigmoid is preferred over ileum. Can be useful when prior surgery or mesenteric reach makes small bowel less attractive. |
| Autoaugmentation | Capacity / Reservoir | Detrusorectomy over intact urothelium to create a low-pressure pseudodiverticulum. Avoids bowel morbidity but offers more modest and less durable gains than enterocystoplasty. |
| Ureterocystoplasty | Capacity / Reservoir | Uses a massively dilated ureter from a poorly functioning renal unit to augment the bladder. Bowel-free option in highly selected anatomy. |
| Gastrocystoplasty | Capacity / Reservoir | Historical gastric augment that reduces chloride reabsorption and mucus but carries hematuria-dysuria, alkalosis, and malignancy concerns. |
| Ileovesicostomy | Capacity / Reservoir | Incontinent low-pressure bladder outlet created with ileum for patients whose native reservoir can be preserved but who cannot safely manage a continent channel or urethral emptying regimen. |
| Transurethral Incision with Injection of Triamcinolone | Outlet / Stenosis | First-line endoscopic salvage for thin bladder-neck contracture or vesicourethral anastomotic stenosis. Often requires repeat treatment. |
| T-Plasty | Outlet / Stenosis | Endoscopic T-pattern incision of the contracture ring to widen the bladder neck more broadly than a single radial cut. Useful for selected recurrent BNC before committing to open salvage. |
| Y-V Plasty | Outlet / Stenosis | Flap-based widening of the bladder neck or proximal anastomosis for recurrent moderate BNC/VUAS when there is usable proximal tissue. |
| Tanagho Flap | Outlet / Stenosis | Anterior bladder wall flap used to reconstruct or lengthen the outlet. Historical neurogenic continence operation with selective modern salvage use. |
| Dorsal BMG for BNC/VUAS | Outlet / Stenosis | Buccal graft augmentation for short-segment obliteration when simple incision is unlikely to suffice but full redo reanastomosis may be avoidable. |
| Subtrigonal Inlay | Outlet / Stenosis | Robotic graft-inlay strategy beneath the trigone for selected stenotic bladder-neck or vesicourethral segments. |
| Transperineal Reanastomosis | Outlet / Stenosis | PFUI-style redo excision and reanastomosis for recurrent or obliterated VUAS, especially when abdominal access is hostile or unnecessary. |
| Appendicovesicostomy (Mitrofanoff Procedure) | Catheterizable Channels | Gold-standard continent catheterizable channel when appendix is available; lowest long-term revision burden among common channel types. |
| Yang-Monti (Monti) Channel | Catheterizable Channels | Retubularized short ileal segment used when appendix is absent or already committed elsewhere; highly continent but more revision-prone long term. |
| Double Monti / Casale Channel | Catheterizable Channels | Length-gaining bowel channels for adults or obese patients with thicker abdominal walls who need more reach than a standard Monti provides. |
| Tubularized Bladder Flap | Catheterizable Channels | Bowel-free catheterizable channel option when native bladder capacity is generous enough to spare bladder tissue for channel creation. |
| Continent Vesicostomy | Catheterizable Channels | Bowel-free continent cutaneous vesicostomy fashioned from native bladder tissue in selected neurogenic or congenital reconstructions when a simple catheterizable stoma is preferable to bowel-based channels. |
| Young-Dees-Leadbetter | Outlet / Continence | Classic trigonal bladder-neck tubularization for neurogenic or congenital outlet incompetence; often part of larger pediatric-style bladder reconstruction. |
| Kropp Procedure | Outlet / Continence | Posterior bladder wall tube used as a continent catheterizable outlet substitute when the native bladder neck is unsalvageable. |
| Pippi-Salle Procedure | Outlet / Continence | Anterior bladder wall flap folded into a continence mechanism; a pediatric neurogenic-bladder reconstruction kept here for completeness. |
| Bladder Neck Closure | Outlet / Continence | Salvage outlet-abandonment strategy for a devastated or irreparably incontinent bladder neck, often paired with a catheterizable channel and, in men, sometimes combined with prostatectomy or urethral abandonment. |