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CONGRESS OF THE ESPU
VS-21 (VS without presentation)
MACEDO PROCEDURE: CONTINENT CATHETERIZABLE
ILEUM-BASED RESERVOIR – STEP-BYSTEP VIDEO
Tiago ROSITO
1
, Eduardo CACHOEIRA
1
, Patric TAVARES
1
, Nicolino ROSITO
2
,
Guilherme MOTA
1
, Fernando ABREU
1
and Brasil SILVA NETO
1
1) Federal University of Rio Grande do Sul, Pediatric and Reconstructive Urology, Porto Alegre, BRAZIL - 2) FFFCMPA,
Pediatric surgery, Porto Alegre, BRAZIL
PURPOSE
Lower urinary tract symptoms in patients with spinal cord injury, multiple sclerosis, or spina bifida
can significantly affect patients quality of life.
Macedo et all described a original procedure that enables the production of a catheterizable channel
made with an ileal flap tube from the same segment used to create the reservoir, we have been
doing this surgery for the last 6 years with good results.
The goal of this video is to demonstrate the step by step of this procedure to facilitate this under-
standing and so that it can be performed easily by other pediatric utologists.
MATERIAL AND METHODS
We presente a case of 16-year-old male patient with spinal cord injury, reduction in bladder capacity
and a urethral trauma due to clean intermittent .
The technique consist of isolating 35 cm segment of the distal ileum. The intestine is detubularized
and a 3 cm flap is created and the ileum reminder is opened longitudinally. The 3 cm flap is cranially
mobilized and tubularized around a 14F Foley tube. The valve continence is reached by embedding
tube over a serous-lined extramural tunnel. The reservoir is anastomosed to the bladder.
RESULTS
The foley catheter is left indwelling through the stoma for three weeks and a cystostomy tube is left
until catheterization start. Total operative time was 200 minutes and patient was discharged home
at POD 10. Blood loss was estimated in 300 ml.
CONCLUSIONS
Our vídeo demonstrate a step-by-step approach a challenging problem in pediatric urology. Macedo
procedure should be considered in patients who need augmentation cystoplasty and a catheteriz-
able channel.