User:Mattm824/Neurogenic bladder dysfunction

Article Draft
General Surgical Care *for general surgical care, this is modified from the original version, citations are in the main article, underlined section is what I contributed to this section*

Surgical interventions may be pursued if medical approaches have been maximized. Surgical options depend on the type of dysfunction observed on urodynamic testing, and may include:


 * Urinary Diversion: Creation of a stoma (from the intestines, called "conduit") on the skin of the abdomen that bypasses the urethra to empty the bladder directly through a skin opening. Several techniques may be used. One technique is the Mitrofanoff stoma, where the appendix or a portion of the ileum (‘Yang-Monti’ conduit) are used to create the diversion. The ileum and ascending colon can also be used to create a pouch accessible for catheterization (Indiana pouch).
 * Urethral stents or urethral sphincterotomy are other surgical approaches that can reduce bladder pressures but require use of an external urinary collection device.
 * Urethral slings may be used in both adults and children (described in pediatric surgical care)
 * Artificial Urinary Sphincters have shown good term outcomes in adults and pediatric patients. An artificial urinary sphincter is comprised of three components: a control pump, an inflatable cuff that goes around the urethra, and a pressure regulating balloon . One study on 97 patients followed for a mean duration of 4 years found that 92% percent were continent at day and night during follow up. However, patients in this study who had intermediate-type bladders underwent adjuvant cystoplasty. Additionally, one study showed that there was no significant difference in success rates between artificial urinary sphincters and sling procedures, however patients tended to need more additional surgeries with the artificial sphincter versus a sling.
 * Bladder Neck Closure is a major surgical procedure which can be a last resort treatment for incontinence, a Mitrofanoff stoma is necessary to empty the bladder.

Pediatric Surgical Care *this section is completely new to the article*

 * Mitrofanoff Surgery: A surgery in which a conduit, such as the small intestine or appendix, is used to divert urine from a high pressure bladder to the skin to create a stoma, where the bladder can be catheterized via the stoma. This surgery is indicated in spina bifida, urethral strictures, urogenital anomalies, and worsening bladder dysfunction that is refractory to medical treatment. Some providers have begun performing these surgery with a minimally invasive robot.
 * Mitrofanoff using the appendix: The appendix is mobilized from the cecum, while still being connected to its blood source (mesentery). A catheter is passed through the appendix to make sure it is patent. The appendix is then connected to the bladder on one side and to the skin of the abdomen on the other side, creating a stoma.
 * Yang-Monti Mitrofanoff: A 2-3 cm segment of the small intestine (ileum) is used. The ileum is then mobilized to the bladder and connected to the bladder on one side and to the skin of the abdomen on the other side, creating a stoma using the intestine.
 * Augmentation Cytoplasty: A class of surgery in which a segment of intestine is used to increase the capacity of the bladder. This surgery is indicated in patients who have low capacity bladders, poorly compliant bladders, and overactive bladder that is refractory to medical treatment.
 * Ileocystoplasty (Most common): A segment of small intestine (ileum) is isolated and disconnected from the rest of the bowel. The rest of the bowel is reconnected. The removed segment is opened up and is attached to the bladder to increase bladder capacity.
 * Stomach, cecum, and sigmoid colon have been used for augmentation, however it is much less commonly used.
 * Detrusorectomy: part of the detrusor muscle of the bladder is stripped away from the bladder to increase capacity.
 * Sling: A class of surgery that is often done for patients who have paralyzed pelvic floors and urinary incontinence
 * Sling suspension in boys: A plane is created between the bladder neck/prostate and rectum to allow a sling to be passed through in order to assist with continence.
 * Sling suspension in girls: A plane is created between the bladder neck and anterior vaginal wall to allow a sling to be passed in order to assist with continence.