Hello Sunltladi,
There are numerous possible causes of spasms and pain following
your type of surgery. I have included all the possible reasons I could
find. Keep in mind that none of these possibilities is intended as a
diagnosis, and is presented here for informational purposes only. If
you are experiencing pain and spasms, please visit your doctor, who is
familiar with your medical history. Something as simple as an
infection, to contractures (scar tissue) to something far more serious
such a perforation, can be causing your continued pain. It?s
imperative that you be seen by your doctor.
Bladder augmentation, using the ileum, is known also as enterocystoplasty.
?Augmentation cystoplasty increases bladder capacity by incorporating
a section of intestine or stomach into the bladder. This treatment is
reserved for severe cases of intractable detrusor hyperreflexia,
especially those associated with a poorly compliant contracted
bladder, and is contraindicated in frail patients.
Pads and special undergarments may be needed for refractory
incontinence. Many products are available, and the choice can be
tailored to the patient.
Condom catheters can be helpful for some men but often lead to skin
breakdown and decreased motivation to become dry and may not be
feasible for men with a small or retracted penis. New external
collection devices may be effective in women. Indwelling urethral
catheters are not recommended for detrusor overactivity because they
usually exacerbate contractions. If a catheter is necessary (eg, to
allow healing of a pressure sore in a patient with refractory detrusor
overactivity), a small balloon should be used to minimize irritability
and consequent leakage around the catheter. If bladder spasms persist,
oxybutynin can be used. Drugs with more potent anticholinergic adverse
effects (eg, belladonna suppositories) should be avoided in the
elderly.?
http://www.merck.com/mrkshared/mmanual/section17/chapter215/215c.jsp
?Following a bladder augmentation, the bladder may not be able to
expel the stored urine by itself. As a result, many patients must
learn to pass a tube backwards through the urethra into the bladder to
catheterize themselves, so that they can empty the bladder if they
cannot drain it by urinating alone. This is called clean intermittent
catheterization (CIC). If the bladder cannot empty itself it is
important to pass a tube (catheter) regularly so that the bladder does
not over expand and rupture.
Before bladder augmentation surgery, routine tests are done to measure
the function and structure of the bladder and kidneys. These tests may
include blood tests, X-rays and bladder pressure studies
(urodynamics). The same tests may be done after surgery to make sure
that the bladder is healing.?
http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=170
Complications of bladder augmentation:
======================================
?Immediately consider perforation of the augmented bladder in an ill
patient because it presents with a variety of symptoms. Flood et al
(1995) demonstrated that 6% of reported augmentation cystoplasty
patients experienced perforation.
Patients may present with an acute abdomen or a vague illness with
nausea, vomiting, and abdominal distention.
Patients who are neurologically impaired may not have abdominal or
pelvic pain. Instead, he/she may present later in urosepsis.
Urine leak from the augment may lead to flank pain from ureteric
obstruction or electrolyte abnormality from peritoneal reabsorption of
urine. Perform a CT cystogram after retrograde administration of
intravesical contrast if the patient is clinically stable.
Patients diagnosed with perforation of the augmented bladder or
patients who are hemodynamically unstable with suspected perforation
require urgent operative exploration and repair. The etiology of
perforation is unclear; however, ischemia, infection, inflammation,
overdistention, and the potential for iatrogenic injury with
self-catheterization may play a role. Rivas et al (1996) showed (in an
animal model) that augmented bladders stressed with infused volume
tend to rupture within the dome (7/11) and at a suture line (4/11).?
http://www.emedicine.com/med/topic3020.htm
?Long term risks of the procedure include peptic ulceration of the
bladder and perforation of the gastric segment. Spontaneous
perforation is rare but it is life threatening and has a 25% mortality
rate. Other risks include bacterial infections, metabolic changes,
urinary tract infections, and urinary tract stones. Nocturnal
incontinence is sometimes a problem after the surgery.?
?Although some patients recover spontaneous voiding function, this
does not occur with reliable predictability. Preoperatively, patients
should be prepared for the likelihood that they will have to perform
lifelong intermittent catherization and irrigation of the augmented
bladder. Other effects are a special diet for up to three months and
pain after surgery.?
http://www.surgeryencyclopedia.com/A-Ce/Bladder-Augmentation.html
?UTI occurs in 51% of enterocystoplasty patients and is associated
with elevated mean urinary nitrosamine levels. E. coli is the
infecting organism in 50% of cases. Antibiotic prophylaxis reduces the
nitrosamine levels to those of the controls. UTI treatment results in
a rapid reduction of elevated nitrosamine levels to control levels.?
(UTI means urinary tract infection)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11711332&dopt=Abstract
?Intestinal obstruction - 3% incidence reported. Ensure closure of
mesenteric windows.
Diarrhoea may occur temporarily especially if a long segment of ileum
is used. This is more of a problem if the ileocaecal valve is used
which reduces the bowel transit time.
B12 deficiency and megaloblastic anaemia. The use of the terminal 20
cm of ileum and the removal of the ileocaecal valve are predisposing
factors.
Metabolic complications - ammonium chloride re-absorption and
acidosis, chronic acidosis leading to bone demineralisation and growth
retardation in children and, with gastrocystoplasty, hypochloraemic
alkalosis.
Haematuria and dysuria syndrome - after gastrocystoplasty.
Tumour formation - at the anastomosis.
UTI's - more common in the presence of PVR. Asymptomatic bacteruria in
patients on ISC should not be treated.
Stones - bladder stones may occur in up to 30% of patients. It is more
common in those who cathetise through the abdominal wall because of
non-dependency. Most are struvite stones. Mucus, debris and urea
splitting organism infection are predisposing factors. Regular
complete bladder emptying is essential.
Delayed spontaneous bladder perforation - no particular intestinal
segment is more predisposed. Patients present with abdominal pain,
distension, fever, sepsis, nausea and vomiting, decreased urine output
and shoulder tip pain. Cystogram is diagnostic. The aetiology is
unknown but catheter perforation from ISC, shearing forces from
adhesions and recurrent bladder filling and emptying, transmural
infection of the bowel, ischaemia and BOO have all been suggested.
Treatment is laparotomy and surgical repair.?
http://www.bui.ac.uk/Tutorials/aug-cyst.htm
?Postoperative complications include urine leakage, continued
incontinence, and kidney problems. Long-term risks include bladder
stones, bladder cancer, and incontinence during and after pregnancy.?
http://www.urologychannel.com/incontinence2/urge/treatment_surg.shtml
?Metabolic hyperchloremic acidosis is a well known result of bladder
augmentation. Boyd [9] first described the disorder in 1931 in a child
who developed chronic acidosis and rickets after bilateral
ureterosigmoidostomy. D'Agostino et al. [10] demonstrated bicarbonate
secretion by the colon after rectal instillation of normal saline
solution and suggested that it contributes to the acidosis. Koch and
McDougall [11] demonstrated that chloride, ammonia, ammonium, and
potassium were the principal ions reabsorbed by the ileal segment.
Chloride is the principal anion reabsorbed, and Hydrogen sup +,
Potassium sup +, and ammonium are the cations reabsorbed, in
equiequivalent amounts to chloride, therefore producing a normal anion
gap. Ammonium absorption constitutes the major mechanism for excess
hydrogen ions in the serum; a bicarbonate ion is secreted in the lumen
in exchange for a chloride ion, and a sodium ion is secreted in
exchange for a hydrogen ion, therefore contributing to the acidosis.
[3].?
http://www.anesthesiology.org/pt/re/anes/fulltext.00000542-199507000-00023.htm;jsessionid=D0uAlV0PTwh7QwLIg2ZRrStEAsmVyCGZrppNnVOKBepIb83BUCNo!1155136469!-949856144!9001!-1
?There is no guarantee the the cystoplasty would eliminate the chronic
bladder infection. Possible complications include the usual
complications resulting from a major abdominal surgery, bowel
obstruction, blood clots, infection, and pneumonia. Also, there is a
risk of developing urinary fistulae (abnormal tubelike passage into
the genitourinary tract) , urinary tract infection, difficulty
urinating, and a rare possibility of increased risk of developing
tumors.
The following are results from a study showing complications from a
patient's perspective for the surgery, suggesting a high degree of
patient satisfaction:
"The patients experienced a significant increase in bladder capacity
and decrease in pressure at capacity (P < 0.0001). Normal upper tracts
remained normal and there was either improvement or stabilization of
hydronephrosis. Twenty-four patients (40.6%) had one or more
complications, with 21 requiring reinterventions. Twenty-five percent
of patients required the reintervention within the first 25 months,
and the median time to reintervention was almost 10 years. Thirty-five
patients took medications such as anticholinergics, antidiarrheals, or
antibiotics. Fifty-six patients were treated with clean intermittent
catheterization (CIC) at a mean interval of 4.6 hours. Seven patients
had some difficulty with CIC. Thirty-nine patients (67%) were dry, and
17 had mild and 3 severe incontinence. Eleven patients (18.6%)
reported bowel dysfunction, although 7 had it preoperatively. Almost
all patients were very satisfied with their urologic management."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=98434056
http://209.51.172.19/forums/Urology/messages/31009.html
?The average life span, following this procedure, barring any
immediate post operative morbidity and mortality, should be as well or
better than matched controls, since the procedure would presumably
help restore or maintain renal function. This is by virtue of
decreasing episodes of kidney infections, and decreasing the bladder
pressure both of which help with better kidney health.
The life span is certainly compromised in patients with deteriorating
kidney function, infection and high blood pressure. The degree of
compromise is dependent on each patient?s particular medical problems.
Based on the little info I have from you, I can only anticipate that
you might be at higher risk than average patient undergoing this
procedure.?
?It did not work for me, and I needed to have my bladder removed
several months later. The other thing you should be aware of is that
there is a chance you may have to catheterize on a regular basis as
some people go into retention after the surgery.?
http://209.51.172.19/forums/Urology/messages/30226.html
?54 of the 56 patients with a bladder augmentation are completely
continent (mean follow-up: 50 months, range: 10 to 83 months). All of
the 49 patients who received a bladder substitution after radical
cystectomy are continent during daytime. Three of these patients who
do not empty their bladder at regular four hour intervals have leakage
during the night (follow-up: 23 to 69 months). The revision rate due
to nipple gliding and subsequent incontinence could be greatly reduced
by the use of staples for fixation of the ileal nipple and the use of
the appendix. For correction of the most frequently occurring
complications standardized techniques have been developed.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1492769&dopt=Abstract
?bladder neck contracture: Scarring of tissue at the bladder neck
as a complication of surgery. May lead to urinary problems that
require further surgery to correct.?
http://www.urologyhealth.org/glossary/index.cfm?letter=B
?In the operation of enterocystoplasty, now widely practised, segments
of bowel are used to augment or replace the urinary bladder. An
occasional complication is perforation, and this may present in
non-specialist settings. We investigated the management of spontaneous
perforations among 264 patients with enterocystoplasty followed by one
surgeon for 2-18 years. Patients' charts were examined for data on
presentation, diagnosis and treatment. 10 patients had thirteen
perforations; data were available for nine perforations in 9 patients.
Mean time from enterocystoplasty to perforation was 45 months.
Presentation was shoulder pain in 1 and abdominal pain (with or
without fever) in 8. Perforation was diagnosed without delay in 3, but
the initial diagnosis was urinary tract infection in 4 and small-bowel
obstruction in 2. Ultrasound was the most useful investigation being
diagnostic in 6 of 7 cases; contrast cystography showed a leak in only
2 of the 6 patients in whom it was performed.
Treatment was successful in 8 cases (surgery 6; percutaneous drainage
2); 1 patient, who remained undiagnosed, was treated medically and
died. Patients with enterocystoplasty need to be educated about this
potentially lethal complication, so that they can alert non-specialist
clinicians to what may have happened. In any patient with
enterocystoplasty who reports abdominal pain or shoulder pain,
perforation has to be ruled out.?
http://drugs-online-usa.com/ref-diagnostic-2/diagnostic-2-research-abs7.1010.html
The above line references this article:
http://www.jrsm.org/cgi/content/abstract/96/8/393
Complications of transureteroureterostomy:
===========================================
?The possibility of delayed complications makes long-term follow-up of
these patients' cases imperative. Late anastomotic leak may present
with urinoma formation, fevers, ureterocutaneous fistula formation,
small bowel obstruction, or ureterointestinal fistula. Occurrence of
any of these problems mandates an evaluation for distal ureteral
obstruction. This may be because of stones, recurrent pelvic disease
such as malignancy, inflammatory disease, abscess, or radiation
injury. Small bowel obstruction may occur many years after surgery and
usually responds to conservative management. Urinary fistulae are
treated initially by ureteral stenting and Foley catheterization.
Place percutaneous nephrostomy tubes bilaterally if stenting is not
successful. Open repair and, finally, nephrectomy are used as last
resorts.?
http://www.emedicine.com/med/topic3068.htm
?? Excision of ureterocele and ureteral reimplantation
? Problematic hematuria and/or bladder spasms
? Damage to bladder neck or continence mechanism
? Injury to the contralateral ureteral orifice
? Compromise of blood supply to the lower pole ureter?
http://www.emedicine.com/med/topic3077.htm
Even though you didn?t want any information on stones (calculi), it
may interest you that contractures (scar tissue) of the bladder may
precipitate bladder stones.
?Etiology: Bladder outlet obstruction remains the most common cause of
bladder calculi in adults. The elevation of the bladder neck and high
postvoid residual cause urinary stasis, which, despite gravitational
forces, cannot overcome the intravesical prostate and prostatic
urethral pressure. Crystals are formed in this static urine;
therefore, larger calculi develop.
Also, patients who have static urine and develop urinary infections
have a higher tendency to form bladder calculi. In a study of patients
with spinal cord injuries (newly acquired neurogenic bladders) who
were monitored for more than 8 years, 36% developed bladder calculi.
Bladder inflammation secondary to external beam radiation or
schistosomiasis also can predispose the patient to vesical calculi.
Another etiologic factor of bladder stones is foreign bodies in the
bladder that act as a nidus for stone formation. These are
subclassified into iatrogenic and noniatrogenic bodies. The first
group includes suture material, shattered Foley catheter balloons, egg
shell calcifications that form on a catheter balloon, staples,
ureteral stents, migrating contraceptive devices, and prostatic
urethral stents. Noniatrogenic causes include objects placed into the
bladder by the patients for recreational and various other reasons.
Metabolic abnormalities are not a significant cause of stone formation
in patients with urinary diversions. In this group of patients, the
stones are primarily composed of calcium and struvite.
In general, if an otherwise healthy person in the United States or
Europe is found to have a bladder stone, a complete urological
evaluation must be undertaken to find a cause for urinary stasis.
Examples include benign prostatic hypertrophy, urethral stricture,
neurogenic bladder, and bladder neck contracture. In females, examples
include an incontinence repair that is too tight, cystoceles, and
bladder diverticula.?
http://www.emedicine.com/med/topic2852.htm
I hope this has helped you out. If any part of this answer is unclear,
please request an Answer Clarification. I will be happy to assist you
further, before you rate this answer.
I wish you the best. Sincerely, Crabcakes
Search Terms
============
augmentation cystoplasty
augmentation cystoplasty + postoperative complications
enterocystoplasty + complications
bladder augmentation + contractures
bladder augmentation + spasms
enteric contractions |
