1653 LONG-TERM OUTCOME OF AUGMENTATION ENTEROCYSTOPLASTY FOR NEUROGENIC BLADDER

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20121653 LONG-TERM OUTCOME OF AUGMENTATION ENTEROCYSTOPLASTY FOR NEUROGENIC BLADDER Sender Herschorn Sender HerschornSender Herschorn Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1485AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the long-term outcomes of augmentation enterocytoplasty (AE) in patients with neurogenic bladder dysfunction and refractory incontinence. METHODS This is a retrospective analysis of adults undergoing AE. Preoperative work-up included cystoscopy, videourodynamics, upper tract imaging, and laboratory assessment. The need for simultaneous continence procedure and/or abdominal stoma was determined preoperatively. AE incorporated detubularized bowel into a widely opened bladder (clam cystoplasty). If the urethra was not usable for catheterization, continent abdominal stomas were done with the urethral outlet made competent at the time. Continence and reoperation rates were determined. RESULTS 145 patients (89 women and 56 men) underwent AE at a mean age of 32 years (range 18-69). 100 were wheelchair bound. Common diagnoses were spina bifida (73), spinal cord injury (47), and multiple sclerosis (9). 21 underwent undiversions from ileal conduits. Bowel segments included 17 colon and 128 ileum with 74 augmentations alone and 71 (59 females and 12 males) with continent abdominal stomas (done mostly with intussuscepted ileum with a tapered efferent limb). Continence procedures were done in 75 females (47 slings, 22 with slings and tapered bladder necks (BN), BN closure in 6) and 43 males (35 slings with BN tapering, 6 slings, and 2 BN closures). Patients were followed for a mean of 7.9 years (median 6.7). Continence was achieved 120 patients (83%). Mean bladder capacity increased from 206 ml preoperatively to 522 ml postoperatively (P<0.05). Mean pressure at capacity decreased from 42 cm of H2O to 14 cm of H2O (P<0.05). Sixty-five (45%) required re-operation. Reoperative surgeries included 30 for bladder stones, 8 BN revisions or closure, 5 conversion to continent stoma, 9 valve revisions, 9 stoma revisions, 2 parastomal hernia repairs, 1 BN closure, and 4 ileal conduits. The first reoperation was at mean of 5 years (median 3.8) and the second at a mean of 2.5 years (median 1.9) later. There were 2 bladder cancers at 4 and 18 years after AE ultimately resulting in death. Successful term pregnancies (2 vaginal and 2 C-sections) were seen in 4 women. CONCLUSIONS Follow up after AE reveals a high continence rate and significant improvement in urodynamic storage parameters. Despite a high rate of reoperation, AE with or without other reconstructive procedures is an effective option for intractable incontinence in these patients. Because of ongoing potential complications judicious long-term follow-up is mandatory. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e668 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sender Herschorn Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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