The surgeons describe their innovative technique in the December 2008 issue of the journal Urology. They have now performed the operation, using the DaVinci robotic surgical system, six times, with good results and no significant complications.
The first patient, treated Feb. 21, 2008, suffered from a very small, spasmodic bladder, a birth defect that led to gradual kidney damage and loss of urinary control.
“We refer to this condition as neurogenic bladder,” said team leader Mohan S. Gundeti, MD, assistant professor of surgery and chief of pediatric urology at the University of Chicago’s Comer Children’s Hospital. “Her bladder could barely hold six ounces. Worse, it produced frequent involuntary contractions, which forced the urine back up into the kidneys, where it slowly but inevitably causes damage, including frequent infections.”
The girl always felt that she urgently had to go to the bathroom. She stopped drinking juice or soda. She even cut back on water, to less than two cups a day. Medication helped a little, but despite two years of trying different treatments, the problem continued to get worse and began to cause kidney damage, which made surgery necessary.
Although Gundeti had performed the operation to enlarge and relax a tiny spasmodic bladder many times, it had never been done robotically–an approach that has produced quicker recovery, less pain and minimal scars in other procedures.
“This is a major, lengthy operation,” he said, “essentially five smaller procedures done in sequence.”
Known as an augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy, the surgery normally begins with a big incision, about six inches long, from above the navel down to the pubic area, followed by placement of retractors to pull the stomach muscles out of the way.