Augmentation cystoplasty remains the most widely accepted reconstructive technique for creating a compliant and large capacity urinary storage unit that protects the upper urinary tract and provides urinary continence for patients with bladder dysfunction owing to noncompliance or reduced functional capacity.<sup>2 Hasan S.T., Marshall C., Robson W.A. , e al. Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction Br J Urol 1995 ;  76 : 551-557  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 5 Mundy A.R., Stephenson T.P. “Clam” ileocystoplasty for the treatment of refractory urge incontinence Br J Urol 1985 ;  57 : 641-646  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 7 Rink R.C., Adams M.C. Augmentation cystoplasty. Textbook of Operative Urology Philadephia: WB Saunders (1990).  914-926

Cliccare qui per andare alla sezione Riferimenti, 8 Smith J.J., Swierzewewski S.J. Augmentation cystoplasty Urol Clin North Am 1997 ;  24 : 745-754

Cliccare qui per andare alla sezione Riferimenti</sup> In 1888 Tizzoni and Foggi demonstrated the feasibility of performing ileocystoplasty in a canine model. Ten years later, Mikulicz performed the first clinical ileocystoplasty.<sup>4 Mikulicz J. Zur Operation der angeborenen Blasenspalte Zentralbl Chir 1899 ;  26 : 641

Cliccare qui per andare alla sezione Riferimenti</sup> The standard enterocystoplasty involves anastomosing an adequate sized well-vascularized patch of bowel with the urinary bladder.<sup>6 Novick A.C. Augmentation cystoplasty Operative Urology Baltimore: Williams and Wilkins (1982).  98

Cliccare qui per andare alla sezione Riferimenti</sup> This procedure is performed classically through an open laparotomy incision using various segments of intestine. Although the use of any bowel segment for augmentation is associated with advantages and disadvantages, the versatility of choosing a particular bowel segment provides a variety of clinical options based on an individualized set of objectives.

Enterocystoplasty is effective in providing a durable increase in bladder capacity and compliance; however, the morbidity and postoperative discomfort associated with the open laparotomy incision are major deterrents. For patients with preexisting debilitating neurologic and other comorbid conditions, the open procedure significantly prolongs hospital stay, increases the metabolic needs for wound healing, and delays postoperative recovery. Laparoscopy has distinct advantages when compared with open surgical procedures, such as decreased postoperative pain and morbidity, improved cosmesis, a shorter hospital stay, and decreased convalescence. Recent studies have indicated that postoperative intra-abdominal adhesions are reduced significantly after laparoscopic surgery when compared with open surgery.<sup>1 Garrard C.L., Clements R.H., Nanney L. , e al. Adhesion formation after laparoscopic surgery Surg Endosc 1999 ;  13 : 10-13  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup>

Despite the established role of laparoscopy in diagnostic and ablative urologic surgery, the use of laparoscopic techniques in reconstruction has been limited because of the technical complexity of the procedures involved. The technical steps in performing laparoscopic bladder augmentation are designed to emulate the open surgical counterpart in every aspect, thereby producing similar functional results with an improved recovery. This article describes the authors' reconstructive technique of laparoscopic enterocystoplasty that has been refined through their initial experience in performing 12 procedures.