**5.2 Augmentation cystoplasty**

The aim of this procedure is to increase the bladder capacity and decrease elevated pressures in the urinary tract through an intestinal patch surgically fixed at the bladder dome. Some contraindications for these procedures are: 1) Any functional or structural disturbance of the gut, 2) Disturbances of hand dexterity to perform intermittent catheterizations, 3) Cognitive disturbances and 4) Significant damage to the renal function. [21] Significant changes have been observed after surgery regarding bladder storage as well as a decrease in filling pressure. Some early complications reported in the recent literature are wound infection (4–6%)

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**Figure 5.**

*of the bladder.*

*Urologic Implications and Management in Spina Bifida DOI: http://dx.doi.org/10.5772/intechopen.94938*

estimated incidence of 10–20%. [23, 24]

(**Figures 5**–**7**).

infections.

**5.3 Urinary diversion**

and intestinal obstruction (3–6%). The mortality rate within this group of patients is reported between 0 and 2.7%. Long-term complications include metabolic disturbances, such as hyperchloremia (16%) and decrease in renal function in patients with a creatinine clearance lower than 15 ml/min (15%) or higher than 40 ml/min (4.1%). [22] Mucus production by the intestinal lining is estimated between 35 and 40 gr/day, which predisposes to stone formation, infection and obstruction. After catheterizations, we perform intravesical irrigations with sodium bicarbonate at a dilution of 0.75% to reduce mucus thickness and attempt to reduce its production

Perforation after bladder-gut anastomosis has been reported in 0.8–13% of procedures, occurring approximately 2 years after surgery, with a mortality rate of 25%. Risk of bladder cancer has been reported 10–20 years after surgery, and is believed to be caused by urinary stasis, nitrosamines, bladder stones, chronic inflammation of the intestinal patch and possible immune mechanisms with an

Cystoscopy surveillance is recommended after a period of 10 years of surgery and in patients that develop hematuria, suprapubic pain or recurrent urinary tract

Ileovesicostomy uses ileum as a bypass between the bladder and skin. This technique represents many clinical problems due to obstruction; furthermore, it predisposes to infections and bladder stones The Ileal conduit technique uses an

*Ileocistoplasty: a segment of ileum is remodeled and anastomosed to the bladder dome to increase the capacity* 

**Figure 4.** *Sacral neuromodulation therapy for refractory cases.*

*Urologic Implications and Management in Spina Bifida DOI: http://dx.doi.org/10.5772/intechopen.94938*

and intestinal obstruction (3–6%). The mortality rate within this group of patients is reported between 0 and 2.7%. Long-term complications include metabolic disturbances, such as hyperchloremia (16%) and decrease in renal function in patients with a creatinine clearance lower than 15 ml/min (15%) or higher than 40 ml/min (4.1%). [22] Mucus production by the intestinal lining is estimated between 35 and 40 gr/day, which predisposes to stone formation, infection and obstruction. After catheterizations, we perform intravesical irrigations with sodium bicarbonate at a dilution of 0.75% to reduce mucus thickness and attempt to reduce its production (**Figures 5**–**7**).

Perforation after bladder-gut anastomosis has been reported in 0.8–13% of procedures, occurring approximately 2 years after surgery, with a mortality rate of 25%. Risk of bladder cancer has been reported 10–20 years after surgery, and is believed to be caused by urinary stasis, nitrosamines, bladder stones, chronic inflammation of the intestinal patch and possible immune mechanisms with an estimated incidence of 10–20%. [23, 24]

Cystoscopy surveillance is recommended after a period of 10 years of surgery and in patients that develop hematuria, suprapubic pain or recurrent urinary tract infections.

#### **5.3 Urinary diversion**

Ileovesicostomy uses ileum as a bypass between the bladder and skin. This technique represents many clinical problems due to obstruction; furthermore, it predisposes to infections and bladder stones The Ileal conduit technique uses an

*Ileocistoplasty: a segment of ileum is remodeled and anastomosed to the bladder dome to increase the capacity of the bladder.*

#### **Figure 6.**

*Colocystoplasty: a segment of colon is remodeled and amastomosed to the bladder dome. Image obtain from hospital Universitario "Dr. José Eleuterio González", shared by Dr. Adrián Gutiérrez González.*

**Figure 7.** *Ileocecocystoplasty: Distal ileum and cecum are used to anastomose to the dome of the bladder.*

ileum fragment which is closed at one end, both ureters are anastomosed to the conduit and the remaining open ileum end is connected to the abdominal wall, urine is collected by an external pouch. [25]

#### **5.4 Catheter drainage**

The permanent use of urinary catheters is not a good option due to the multiple complications that could develop. These include recurrent infections, meatal erosion, traumatic hypospadias, and stone formation. However, this technique can be used in cases with no other alternative options. If this were the case, the possibility of a suprapubic tube would be the most suitable option, which presents fewer complications. It is reserved only for patients with bladder emptying disturbances. This procedure is not recommended for patients with hyperactive neurogenic bladder, as urine leak surrounding the catheter entrance could appear. [26]

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**Author details**

and Daniel García-Sánchez1,2

Nuevo León, Monterrey, Mexico

2 UroContinent, Monterrey, Mexico

provided the original work is properly cited.

Adrián Gutiérrez-González1,2\*, José Iván Robles-Torres1,2

\*Address all correspondence to: dradriangtz@gmail.com

1 Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Urologic Implications and Management in Spina Bifida DOI: http://dx.doi.org/10.5772/intechopen.94938*

*Urologic Implications and Management in Spina Bifida DOI: http://dx.doi.org/10.5772/intechopen.94938*
