Operative note 37 Advanced
Functional bladder surgery
What it does: rebuild or control a difficult bladder.
Augmentation (ileocystoplasty)
- 20-25 cm ileum, opened along its far border.
- Bladder split front to back. The halves must not pull together again.
- Patch sewn in, 2 running 3/0 threads.
- Supra + urethral catheters + drain.
- Washouts 3x a day, against mucus.
- Supra out day 13. Urethral day 14. Cystogram if any doubt.
Detrusor myectomy
- Blue dye in the bladder.
- Inverted-U muscle cut over the dome.
- Muscle peeled OFF the lining underneath.
- Hole in the lining ~50%. Close 6/0. Drain.
- Never over-fill after.
Artificial sphincter (AUS)
- Obsession with clean technique. Minimal traffic. Double gloves. Wash the field.
- Bulbar cuff after prostate surgery. Bladder neck cuff: women, children, catheterisers.
- ContiClassic balloon 60-69 (bulbar) or 70-79 (neck) cmH2O. Redo for wear: higher balloon, or cuff 0.5 cm smaller. Irradiated: lower balloon.
- Pump in a dependent scrotal pouch in front of the LEFT testis. Button forward.
- Off for 6 weeks. Activate in clinic. Teach cycling.
- 2026 update: Device by approach: Rigicon ContiClassic for the perineal incision, AMS 800 for the penoscrotal. Erosion 3-10%. Infection 1-5%.
- 2026 update: Penoscrotal approach: before the incision, pull the shaft straight up off the scrotum. Hold it on the pubic region with a stay stitch through the glans.
- 2026 update: Sacral neuromodulation: 2 stages. Test wire. Over 50% better on a diary = permanent wire.
- 2026 update: Botox 100 U in 10 mL: 20 x 0.5 mL, into the bladder wall, spare the trigone. Effect 6-9 months. Teach self-catheterisation first.
From the UroRef Operative Quick Guide.