Ten years’ experience of augmentation cystoplasty for varied indications and its outcome

Background: The aim of the study was to evaluate long term efficacy and complications of augmentation cystoplasty in patients with bladder dysfunction.  Methods: Our series comprises of 30 patients undergoing enterocystoplasty from March 2009 till December 2019. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age of patients was 7 years and their mean follow up was for 4 years. Major complications occurred in 5 patients which were successfully managed and minor complication in 8 patients. Of these 16 patients were with neurogenic bladder and 14 with non-neurogenic bladder. The primary etiology of non-neurogenic bladder was extrophy epispadias complex (10 patients), posterior uretheral valves (2 patients), anterior uretheral valve (1 patient), and bilateral ectopic ureter (1 patient). The primary etiology of neurogenic bladder was meningomyocele (4 patients), anorectal malformation with vertebral anomalies (7 patients), partial sacral ageneis (4), nonneurogenic neurogenic bladder (1 patient). Relative continence was achieved in 97%. The preoperative serum creatinine and blood urea nitrogen (BUN) at the time of bladder augmentation (termed  creatinine-1 and BUN-1)and the serum  creatinine and BUN at the last follow up after bladder augmentation (termed  creatinine-2 and BUN-2)were sought and compared using chi square test showed statistically significant improvement (p<0.01).Conclusions: Augmentation cystoplasty is a necessary and safe procedure to increase the functional capacity of small contracted and poorly compliant bladder and allows patients to achieve relative continence and preserves renal function.

Clean Intermittent Catheterization after Sigmoid Augmentation Cystoplasty and Abdominal Sigmoidostomy: A Case Report / 中国康复理论与实践

Objective:To summarize the nursing care of a patient with clean intermittent catheterization after sigmoid augmentation cystoplasty and abdominal sigmoidostomy for the treatment of neurogenic bladder. Methods:On October 16, 2017, one patient with neurogenic bladder was admitted to Beijing Bo'ai Hospital. Psychological instructions were given to the patient after surgery. Catheter of appropriate type and material was selected, and then the patient was instructed to implement correct and regular clean intermittent catheterization procedures. At the same time, nursing care of abdominal sigmoidostomy was carried out. In order to prevent tube blocking, bladder irrigation was implemented at regular intervals. Follow-up visit was scheduled. Results:After four-month follow-up, the patient completed the whole procedures successfully, and its renal function was protected without severe urinary tract infection, also the patient was with good social adaptation. Conclusion:Comprehensive nursing care is needed in patients after sigmoid augmentation cystoplasty and abdominal sigmoidostomy. Correct and regular clean intermittent catheterization is critical. Psychological nursing, care of abdominal sigmoidostomy and tube blocking prevention should not be neglected, also long-term follow-up is of great significance for the outcome.

Initial experience of ileal ureter replacement combined with augmentation cystoplasty in the treatment of ureteral stenosis with contracted bladder / 中华泌尿外科杂志

Objective To explore the availability and safety of ileal ureter replacement combined with ileal augmentation cystoplasty in treating ureteral stenosis with contracted bladder.Methods From August 2015 to November 2018,three patients who underwent ileal ureter replacement combined with augmentation cystoplasty were treated with ileal ureter replacement combined with augmentation cystoplasty.There were 1 male and 2 females with the age ranging from 34 to 55 years (mean 39 years).Two patients suffered from left ureter stenosis,and one patient had stenosis on the both sides.The length of the ureter stenosis ranged from 6 to 18 cm (mean 9.8 cm).The preoperative bladder capacity ranged from 60 to 150 ml (mean 103.3 ml).In the surgery,part of ileum was used to replace the ureter,and the distal intestine was made into U-shape to enlarge the bladder.Results All operation were completed successfully.The operation time ranged from 220 to 400 min (mean 303.0 min),and the blood loss ranged from 150 to 500 ml (mean 283.3 ml).Laparoscopic surgery was performed in 1 case and open surgery in 2 cases.Three weeks after the surgery,the bladder volume underwent cystography ranged from 300 to 400 ml (mean 360.0 ml).Three months after the surgery,the postvoid residual urine volume ranged from 20 to 50 ml (mean 33.3 ml).Postoperative frequency and urgency of urine were completely relieved in 1 case,alleviated in 2 cases.Flank pain was completely relieved in 1 case,and alleviated in 2 cases postoperatively.The serum creatinine of 2 patients mildly increased after the surgery,while 1 patient remained stable.For complications,1 patient had urinary infection,and 1 patient suffered from metabolic acidosis.Conclusions Ileal ureteral replacement combined with augmentation cystoplasty can be the choice of treatment for long segment ureteral stenosis and enlarge the bladder simultaneously.The postoperative complications and the kidney functions should be regularly followed up.

Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center / 대한배뇨장애요실금학회지

PURPOSE: Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. METHODS: A retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables. RESULTS: Renal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected. CONCLUSIONS: We consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.

Experiences of Renal Transplantation after Correction of Dysfunctional Contracted Bladder / 대한이식학회지

BACKGROUND: There is some controversy about the safety of renal transplantation in patients with an augmentation cystoplasty. The purpose of this study is to assess the early and long-term results of renal transplantation in 6 patients who underwent augmentation cystoplasty to correct bladder dysfunction. METHODS: We retrospectively reviewed the surgical outcome of renal transplants in 6 recipients with augmentation cystoplasty including one ileal conduit. The etiology of bladder dysfunction was neurogenic bladder with detrusor hyperreflexia (4 pediatric patients) and renal tuberculosis (2 adult patients). Augmentation cystoplasty was performed before transplantation in all patients. The bowel segments used in the augmentation cystoplasty included stomach in 2 (including one revision case with ileum), ileum in 3, ileocecal segments in 1, and sigmoid colon in 1 patients. The mean patient's age at transplantation was 25.5 years. Four transplants were from living donors. The donor ureter was anastomosed to ileal conduit in 1, native bladder in 2, and the bowel segment in 3 patients. RESULTS: All transplanted kidneys were functioning at a mean follow-up of 103 months (range 5 to 220). The mean serum creatinine level was 1.0 mg/dl (range 0.7 to 1.8). Acute rejection was diagnosed in protocol biopsy in one patient without graft function deterioration. Four patients admitted for febrile urinary infection during the follow up periods. CONCLUSIONS: Augmentation cystoplasty is a safe and effective method to restore the renal function in patients who have noncompliant bladders. Renal transplantation can be performed safely after augmentation cystoplasty.

The Long-Term Outcomes of Augmentation Cystoplasty in Spinal Cord Injury Patients / 대한비뇨기과학회지

PURPOSE: The long-term outcomes of augmentation cystoplasty were investigated in spinal cord injury (SCI) patients with a neurogenic bladder, and included a study of the complications and patients' satisfaction. MATERIALS AND METHODS: 19 SCI patients that underwent an augmentation cystoplasty, between 1988 and 1994, were retrospectively reviewed. The mean follow-up period was 120, ranging from 94 to 169 months. The changes in the intravesical pressure, bladder capacity and complications were investigated. Urological examinations, including history taking, medical records, radiological evaluations and urodynamic studies were undertaken. All the patients were interviewed by direct contact. RESULTS: Six months postoperatively, the urodynamic results showed significantly decreased intravesical pressures and increased bladder capacities. The intravesical pressure (cmH2O) was decreased from 89.0+/-16.49 to 28.0+/-5.69 (p<0.05), and the functional bladder capacity (ml) was increased from 125.0+/-53.30 to 480.0+/-43.33 (p<0.05). From the long-term follow-up, 10 years postoperatively, the results were similar to the previous data (21.0+/-3.88cmH2O and 510.0+/-60.27ml). The symptomatic urinary tract infections had disappeared, but the asymptomatic bacteriuria continued. The vesicoureteral reflux was eliminated, and the renal function normalized, in all patients. The hydronephrosis had disappeared in most patients (89%). A few postoperative complications were reported. Most patients were very satisfied symptomatically (89%), with no patient expressing dissatisfaction. A clean intermittent catheterization (CIC) was performed every 4 to 6 hours, with the mean volume of drained urine was 450, ranging from 400 to 600ml. CONCLUSIONS: Augmentation cystoplasty could be an excellent method of treatment in selected patients with SCI. There were no significant complications, and a high degree patients' satisfaction, on the long-term follow-up.

The Long Term Results of Augmentation Cystoplasty in Contracted Bladder / 대한비뇨기과학회지

PURPOSE: In contracted bladder of various etiologies, if many of conservative managements fail, a surgical treatment seems to be the only therapeutic approach. We tried to evaluate the long term results of aug mentation cystoplasty including the postoperative complication and the degree of satisfaction in patients. MATERIALS AND METHODS: From 1989 to 1988, augmentation cystoplasties had been performed in 11 patients with contracted bladder of various etiologies. We reviewed the patients' medical records including the result of urodynamic examinations, retrospectively. Postoperative follow-up periods were 9 to 114months (mean:61months). Patients were interviewed by telephone. RESULTS: Urinary frequency, nocturia, dysuria and suprapubic pain were improved in all patients, but dysuria persisted in one patient with tuberculous cystitis. Clean intermittent catheterization (CIC) was done in there of 11 patients due to large volume of residual urine. The volume of residual urine was 200-300ml in one with hyperreflexic neurogenic bladder, and 100-200ml in two with interstitial cystitis. Self voiding was possible in 8 patients with residual urine volume less than 90ml. Almost all patients were very satisfied symptomatically in the telephone survey. There were no significant complications which required surgical revision. CONCLUSIONS: It is concluded that augmentation cystoplasty could be an excellent method of treatment for selective patients with contracted bladder, who have not improved symtomatically by medication or conservative management.

Bladder Cellular Regeneration after Augmentation Cystoplasty with Human Dura Mater (Tutoplast(R)) in Rat / 대한비뇨기과학회지

PURPOSE: To study the cellular events occuring during bladder development and regeneration, we used the human Dura mater (Tutoplast(R)) for augmenting the rat bladder. We compared their intravesical threshold pressure and volume, and observed the regenerative capacity of urothelium and smooth muscle cell within Tutoplast(R). MATERIALS AND METHODS: Among a total of 67 rats, 11 normal rats were checked their intravesical threshold pressure and volume(Group 1). 9 rats underwent only vesicotomy(Sham operation) and were checked their threshold pressure and volume at 2 months and 3 months postoperatively(Group 2). 47 rats underwent augmentation cystoplasty with Tutoplast(R) after partial cystectomy, which were checked pressure and volume at 1 day, 3-7 days, 2-4 weeks, 2-6 months postoperatively(Group 3). Specimens were examined histologically to assess the regeneration of urothelium and smooth muscle cell on the graft. RESULTS: There was a significant increase in intravesical volume of group 3 compared with group 1 and 2. There was a significant decrease in intravesical pressure of group 3 compared with group 2, but there was no significant difference between group 1 and 3. The specimens of 1 day postopratively showed inflammatory findings. Epithelialization on the graft margin was noted at 3 days postoperatively. At 7 days postoperatively, there was epithelial hyperplasia on the graft site. At 2 weeks postoperatively, there was a partial absorption of Tutoplast(R) as well as favorable progression of epithelialization. Smooth muscle regeneration and complete epithelialization were shown at 3 months postoperatively and absorption of Tutoplast(R) was completed thereafter. CONCLUSIONS: The regeneration of bladder cellular constituents within Tutoplast(R) will be valuable for further understanding the mechanism controlling bladder development and regeneration. Further studies will be necessary for using this method as an alternative strategy to the classical bladder augmentation.

An Experience of Spastic Neurogenic Bladder Treated with Augmentation Cystoplasty and External Urethral Sphincterotomy / 대한비뇨기과학회지

A 41-year-old man with a 12-year history of urinary incontinence and frequency was presented our hospital. He had a spinal cord injury after fell down from a utility pole. Spastic neurogennic bladder and detrusor external sphincter dyssynergia was diagnosed and augmentation cystoplasty was performed. And we performed additional external sphincterotomy to avoid intrmittent self catheterization. He can retain as much as 800m1 of urine without urinary incontinence and voids with abdominal pressure and retains little residual urine. We report the good result of additional external urethral sphincterotomy after augmentation cystoplasty.

Evaluation of the Augmentation Cystoplasty in the Pediatric Neurogenic Bladder / 대한비뇨기과학회지

From 1985 to 1995, 13 children with neurogenic bladder underwent augmentation cystoplasty. Diagnosis in these 13 children included Meningomyelocele in 11 and unknown origin in 2. Indications for augmentation cystoplasty were persists incontinence in 6 patients and progressive upper urinary tract deterioration in Bowel segments were used for augmentation included sigmoid colon in 1 patient, ileocecal segments incontinence in 6 patients stomach in 3. Dilated ureter also was used in 1 patient. Postoperatively, all the patients have stable upper tracts radiographically and stable or improved renal function. Of 13 patients 12 require clean intermittent catheterization to empty bladder and 10 are completely continent. After operation, bladder capacity increased from 155 ml to 305 ml and there were significant increases in bladder compliance. Hypereflexia was present in 5 patients before operation and in 3 patients after operation. There has been no surgical mortality. Postoperative complications occurred in 4 patients included mild ileus in 2 patients, mucus obstruction in 1, mild hematuria in 1, metabolic alkalosis in 1 and superficial wound infection in All complications were transient and managed medically. the kind of bowel segments did not seem to influence results. We think that augmentation cystoplasty is a therapeutic modality that should be considered as a viable treatment option in selected patients with neurogenic bladder dysfunction.

Augmentation Cystoplasty with Mainz Pouch in Tuberculous Contracted Bladder / 대한비뇨기과학회지

A variety of surgical techniques for augmentation cystoplasty have been developed. To evaluate the clinical availability of the augmentation cystoplasty using the Mainz pouch, We reviewed 8 patients with tuberculous contracted bladder who underwent construction of a Mainz pouch. Preoperative frequency was dramatically improved in all of 8 patients. Mean bladder capacity increased from 36 ml preoperatively to 534ml postoperatively. On the uroradiologic study, preoperative hydronephrosis was improved or stable in 9 of l0 renal units and was aggravated in 1 renal unit. Preoperative vesicoureteral reflux disappeared in all of 3 patients. Urodynamic study revealed mean residual urine of 70ml and maximal intravesical pressure during contraction of 65cmH2O after cystoplasty. There were no significant complications which required surgical revision.

Antirefluxing Augmentation Cystoplasty with Ileocolic Pouch in Single Kidney with Refluxing Contracted Bladder / 대한비뇨기과학회지

The contracted bladder has a high intravesical pressure, noncompliant, small-capacity bladder. The goal of augmentation cystoplasty is the preserving of renal function at low pressure during storage, and effective voiding without residual urine. Even though, there is some controversy, the vesicoureteral reflux with contracted bladder influence on renal function. Herein, we report a case of contracted bladder with unilateral functioning kidney and vesicoureteral reflux, which was treated with augmentation cystoplasty with ileocolic pouch (Le bag).

Functional Analysis of Anti-Refluxing Augmentation Cystoplasty / 대한비뇨기과학회지

Augmentation cystoplasty using bowel is effective method for the functional enlargement of bladder capacity in contracted bladder due to various causes. Prevention of vesicoureteral reflux after augmentation cystoplasty is still controversial but generally accepted that prevention of reflux is essential for good long term result. Therefore, antireflux augmentation cystoplasty including the use of ileocecal valve and hemi-Kock intussuscepted ileal nipple valve has been used recently for this purpose. Herein, we report the result of 3 cases of ileocecal cystoplasty and 6 cases of hemi-Kock ileocystoplasty. Hemi-Kock ileocystoplasty is better than ileocecal cystoplasty in a viewpoint of reflux prevention and continence, but complication is more common and serious in hemi-Kock ileocystoplasty than ileocecal cystoplasty. It is considered that azotemia is not contraindication for these procedures, and renal function deterioration has not been observed postoperatively.