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Enterocystoplasty, commonly known as bladder augmentation, is a surgical procedure that involves the use of a segment of the intestine to enlarge the bladder. This technique is particularly beneficial for patients suffering from bladder neuropathy and high-pressure detrusor contractions, conditions that can lead to significant urinary dysfunction. The primary goal of enterocystoplasty is to reduce intravesical pressure, thereby improving bladder capacity and function. The procedure begins with a cystoscopic examination of the bladder, which allows the surgeon to assess the bladder's condition and plan the surgical approach. During the operation, internal ureteral stents or external ureteral catheters are placed to ensure proper urinary drainage. Following the cystoscopic evaluation, a Foley catheter is inserted to facilitate urine management. The surgical approach involves a midline incision in the abdomen, through which the peritoneum is opened to access the abdominal cavity. The small bowel is then isolated and temporarily packed out of the surgical field to provide a clear view of the operative area. The ureters, which are the tubes that carry urine from the kidneys to the bladder, are carefully identified and protected throughout the procedure. A specific segment of the colon or ileum is selected for augmentation, which is then isolated and harvested. The remaining bowel segments are reconnected through anastomosis, restoring bowel continuity. The harvested intestinal segment is detubularized and reshaped into a graft, which can take on various configurations such as U-, S-, or W-shaped, depending on the surgical plan. The bladder is then bivalved to facilitate the attachment of the intestinal graft. In addition to the Foley catheter, a large-caliber suprapubic catheter is placed to ensure adequate urinary drainage postoperatively. Finally, the intestinal graft is sutured to the bladder, and drains may be placed as necessary before the abdomen is closed around the drains, completing the procedure.
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The procedure of enterocystoplasty is indicated for patients with specific urinary conditions that necessitate bladder augmentation. These indications include:
The enterocystoplasty procedure involves several critical steps to ensure successful bladder augmentation. These steps include:
Post-procedure care following enterocystoplasty involves monitoring the patient for any complications and ensuring proper recovery. Patients may require close observation for signs of infection or issues related to urinary drainage. The placement of both a Foley catheter and a suprapubic catheter allows for effective management of urine output during the initial recovery phase. Patients are typically advised on fluid intake and may need to follow specific guidelines regarding activity levels as they heal. Follow-up appointments are essential to assess bladder function and the success of the augmentation, as well as to manage any potential complications that may arise during the recovery period.
| Short Descr | REVISION OF BLADDER & BOWEL | Medium Descr | ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS | Long Descr | Enterocystoplasty, including intestinal anastomosis | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 112 - Other OR therapeutic procedures of urinary tract |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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