Chester C. Winter

“Cup-patch” Technique of Ileocystoplasty for Bladder Enlargement or Partial Substitution

THE IDEA of enlarging or replacing the urinary bladder with isolated segments of bowel is not new in urologic surgery. However, Scheele’s description (1923) of his “ring plastik” to enlarge the bladder was more or less forgotten until Couvelaire in 1950 initiated the present era of interest in bladder enlargement and partial substitution by isolated loops of ileum. Various types of ileocystoplasty have been tried and enthusiastically reported by European authors, viz., Cibert, Tasker, Pyrah, Annis, May and associates, Schwartz, Glaser, and Jacobs. Couvelaire’s review of the literature, from the time of Mikulicz in 1898, is the best summary of the literature to that time. In 1957, Quenu presented the most recent complete review. In the American literature, however, there are to date fewer articles concerning this useful operation. Shoemaker and co-workers described experimental and clinical studies in which they used isolated ileac loops, denuded of mucosa and turned inside out, to form seromuscular grafts for bladder and ureteral replacement. This procedure is said to obviate difficulty with mucus formation and electrolyte exchange. Shoemaker’s article with Marucci19 contains a review of the background literature to be found in American journals. Campbell recently described an equivocal success with Shoemaker’s technique, but the procedure has not yet found wide acceptance. Ferris has succinctly reported his success with a patch type of ileocystoplasty (similar to that described by Tasker) in 2 patients treated at the Mayo Clinic. Our own interest in this problem began in 1953 when animal experiments were initiated to study partial substitution of the bladder with isolated segments of both ileum and sigmoid colon in the dog.22 To date we have employed ileocystoplasty in 17 patients utilizing a more complex variant of the “patch” technique described by Tasker. The surgical procedures have been technically satisfactory. There has been 1 death from coronary thrombosis. There have been no serious complications related to the surgery. Late results of the procedure are to be described elsewhere. In the present article the technique is described in detail as we have used it.