Cleveland Clinic Foundation
Description: A minimally invasive surgical technique offers a life-changing
solution to patients with nerve-related bladder disorders who must often
find alternative ways to manage their bladders.
Scott Tennant, 216/444-8927 or
Jim Armstrong, 216/444-9455
Cleveland Clinic surgeons pioneer laparoscopic technique
Shirley Clark's life changed completely after a car accident 12 years ago left her a quadriplegic paralyzed from the chest down. Even the experience of using the restroom was difficult for Ms. Clark, who for several years after the accident used an indwelling Foley catheter and leg bag to drain her bladder.
But thanks to surgeons at the Cleveland Clinic, her quality of life has dramatically improved. Ms. Clark is believed to be the first person in the world to have undergone what is known as "laparoscopic enterocystoplasty with catheterizable stoma." In this minimally invasive procedure, surgeons use intestinal tissue to increase the size of the bladder, while also forming a conduit through which a person may drain his or her bladder. Ms. Clark, for example, now inserts a disposable catheter through a hole in her navel four or five times daily, allowing urine to pass out of her body.
"I had all sorts of problems when I was wearing the Foley catheter," said Ms. Clark, a 31-year-old secretary who lives in Lodi, Ohio. "I constantly had urinary tract infections that required me to take antibiotics, and I also suffered from bladder stones quite frequently. Self-catheterization was difficult, and I had to get completely undressed for it. Ever since my operation, though, I haven't had to worry about those things. I've also had more freedom with my wardrobe, since I no longer have to wear a leg bag."
Enterocystoplasty is routinely performed using large, open incisions on people with a variety of nerve-related bladder problems, including accident victims and a large percentage of those with multiple sclerosis. But the new laparoscopic technique, pioneered by Cleveland Clinic physicians, uses a series of five very small incisions and offers better cosmetic results and faster recovery times.
"This is a technically complex procedure, but it offers innumerable benefits to the patient," said Clinic urologist Raymond Rackley, M.D., who has routinely performed these laparoscopic enterocystoplasties in cooperation with colleagues Inderbir Gill, M.D., and Anthony Senagore, M.D. "These are people with small bladder capacities who are unable to get to the toilet or catheterize themselves without assistance. This operation offers them a measure of independence they did not previously enjoy and a means of bladder management that is simpler and more socially acceptable to them."
The Cleveland Clinic Foundation, founded in 1921, integrates clinical and hospital care with research and education in a private, non-profit group practice. At the Cleveland Clinic and Cleveland Clinic Florida in 1998, nearly 1,000 full-time salaried physicians representing more than 100 medical specialities and subspecialties provided for 1,735,484 outpatient visits and 49,893 hospital admissions for patients from throughout the United States and more than 80 countries. In 1997, The Cleveland Clinic Health System was formed. It now comprises The Cleveland Clinic Foundation, Euclid, Fairview, Hillcrest, Huron, Lakewood, Lutheran, Marymount and South Pointe hospitals, and the Cleveland Clinic Children's Hospital for Rehabilitation. With 3,010 staffed beds, the Cleveland Clinic Health System offers broad geographic coverage, a full continuum of care, improved quality and lower cost of care to Northeast Ohio residents.