Bladder Augmentation Techniques in Women

Abstract

Augmentation cystoplasty is performed in women for a variety of indications, including neurogenic bladder dysfunction, inflammatory diseases, small fibrosed bladders, idiopathic urge incontinence and enuresis. The preoperative evaluation, surgical techniques and postoperative management are reviewed. Complications of stone formation, urinary tract infections, mucus production, metabolic disturbances, hematuria and dysuria syndrome, tumors and perforations are addressed. In addition, alternative techniques such as ureterocystoplasty, autoaugmentation, seromuscular cystoplasty and the future of augmentation of the bladder utilizing techniques of tissue engineering are discussed. The management of pregnancy in women who have previously undergone augmentation cystoplasty is also reviewed.

Forty-five-year follow-up on the renal function after spinal cord injury

“…Since its clinical introduction by Cartwright and Snow (202) in children and by Stöhrer (203) in adults, this procedure for reducing DO or improving low detrusor compliance has gained popularity because of its acceptable long-term results, its low surgical burden, its low rate of long-term adverse effects, its positive effect on the patient's QoL, and because it does not preclude further interventions (1,4,(202)(203)(204)(205)(206)(207)(208)(209)(210)(211)(212)(213)(214)(215)(216)(217)(218)(219)(220)(221).…”

“…A number of different techniques have been published. The results of the various procedures are very good and comparable (208,(210)(211)(212)(215)(216)(217)(255)(256)(257)(258). Bladder substitution to create a low pressure reservoir may be indicated in patients with severely thick and fibrotic bladder wall.…”

“…Bladder substitution to create a low pressure reservoir may be indicated in patients with severely thick and fibrotic bladder wall. Scaffolds, probably of tissue-engineered material for bladder augmentation or substitution or alternative techniques, are promising future options (216,(259)(260)(261)(262)(263)(264).…”

Full-Thickness Hysterocystoplasty for Management of a Large Bladder Defect: Experimental Study in Goats

“…Many augmentation cystoplasty or neobladder techniques have been used routinely for treatment of reduced bladder compliance and capacity secondary to bladder infection and inflammation [27], neurogenic dysfunction or congenital bladder disorders [16], detrusor over activity [10], large bladder defects [8,9], bladder necrosis [30] and bladder tumors [7,12]. Although encouraging animal and human results have been reported with different techniques, each technique had its own limitations, complications and disadvantages [2,4,11,27].The ileum and colon have been used for decades for reconstruction of the bladder, in spite of the harmful contact of urine with the mucosa of the augmenting patch [23], which is predisposed to multiple short-and/or long-term complications like chronic bacteriuria or mucous secretion [1,23], stone formation [1,11,29], disturbance of calciumphosphate metabolism with potential bone growth retardation [24,28], altered hepatic and electrolyte metabolism [24], gastrointestinal motility disorders [23], augmenting patch perforation [1,6] and malignant transformation of the augmenting patch [1,14].Gastrocystoplasty has been described as an alternative technique; unfortunately, as the popularity of gastrocystoplasty increased, so did awareness of its potential complications, like hematuria, stricture, rupture of the gastric segment, adenocarcinoma formation and hypochloremic alkalosis, which is much more difficult to treat than chronic metabolic acidosis. Accordingly, gastrocystoplasty is no longer a safe method for bladder augmentation [4,11,26].…”

“…Many augmentation cystoplasty or neobladder techniques have been used routinely for treatment of reduced bladder compliance and capacity secondary to bladder infection and inflammation [27], neurogenic dysfunction or congenital bladder disorders [16], detrusor over activity [10], large bladder defects [8,9], bladder necrosis [30] and bladder tumors [7,12]. Although encouraging animal and human results have been reported with different techniques, each technique had its own limitations, complications and disadvantages [2,4,11,27].…”