Application of appendicular-based cecal flap for less invasive augmentation cystoplasty: A novel technique

Objectives: To evaluate the use of a new modified technique for augmentation cystoplasty on selected cases, both in terms of improvements in bladder urodynamics and creating an ideal conduit for clean intermittent catheterization. Methods: Ten patients suffering from intractable low-compliance bladder and reasonable capacity underwent appendicular-based cecal flap augmentation cystoplasty. The procedure comprised the isolation of a 10 to 12 × 3 to 5-cm cecal flap on the base of the appendicular pedicle, by which the bladder was augmented and the appendix was brought out through the abdominal wall for catheterization. Without any bowel anastomosis, the cecal anterior wall was repaired. Results: After a mean follow-up of 23.8 months, 9 of 10 patients became continent. Postoperative urodynamic study revealed a 53.8% increase in mean maximal cystometric capacity (from 171.4 to 263.7 ml; p = 0.012) and a 7.7-fold increase in mean bladder compliance (from 3.39 to 26.66 ml/cm H₂O; p = 0.012). Mean maximal detrusor filling pressure decreased by 79% (from 62.2 to 13 cm H₂O; p = 0.012). Renal function remained stable in all patients. Appendicular stoma was easy to catheterize, and no stomal stenosis occurred during the follow-up period. Conclusions: Early results of this less invasive technique could be promising in patients with high filling pressure and acceptable maximum bladder capacity.