Long‐term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow‐up

Abstract

What ' s known on the subject? and What does the study add? Suprasacral spinal cord injuries can result in intractable detrusor overactivity adversely effecting patients ' quality of life. It can lead to high pressure bladder resulting in urinary incontinence and deterioration of upper tract function. Augmentation cystoplasty is an accepted procedure in treating refractory neurogenic detrusor overactivity.Several publications have reported on the short-to intermediate-term outcomes with augmentation cystoplasty in patients with spinal cord injury. However, it is not known how these outcomes alter over a longer period. This study has a follow-up of at least 10 years. It evaluates the durability of this procedure over the longer term. It also assesses the patients reported outcome over this period. This data can help counsel patients better when considering augmentation cystoplasty as a treatment option for the management of refractory neurogenic detrusor overactivity secondary to spinal cord injury. OBJECTIVE• To report the long-term outcomes of augmentation ileocystoplasty (AIC) in patients with spinal cord injury (SCI), with a minimum follow-up period of 10 years. PATIENTS AND METHODS• We retrospectively analysed all operations performed by a single surgeon at a specialist spinal unit.• Outcomes were measured by comparing preoperative and follow-up videocystometrograms (VCMGs).• Complications were identifi ed from case notes and the surgery database.• Subjective assessment was through a previously validated questionnaire. RESULTS• The mean (range) follow-up was 14.7 (10.5 -20.3) years. There were 19 patients (12 males) with a mean (range) age at time of surgery of 28.9 (12 -52) years. The mean (range) period from injury to surgery was 4.5 (0.3 -22) years. All had suprasacral injuries.• The VCMGs showed a signifi cant improvement in bladder capacity and a decrease in intravesical pressures ( P < 0.001).• Long-term complications included bladder stones ( n = 4); urosepsis ( n = 2); vesico-ureteric refl ux ( [ VUR ] n = 2), VUR requiring ureteric re-implantation ( n = 1); neurogenic detrusor overactivity ( [ NDO ] n = 1); and laparatomy for bowel obstruction ( n = 1). Surveillance cystoscopies did not detect any bladder neoplasms.• The response rate for the questionnaire survey was 14/17; 13/14 patients were satisfi ed with the operation such that they would consider it again or recommend it to a friend. No patient reported any signifi cant changes in either bowel habit or sexual function. CONCLUSIONS• We found that AIC has excellent long-term outcomes in the defi nitive management of refractory NDO in patients with SCI.• The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients. KEYWORDSspinal cord injury , ileocystoplasty , augmentation cystoplasty Study Type -Therapy (case series) Level of Evidence 4

The management of urinary incontinence in the male neurological patient

“…Augmentation cystoplasty can be combined with a continent catheterizable cutaneous urinary diversion to facilitate ISC in patients with limited dexterity. Recent long-term data confirm previous data on efficacy demonstrating sustained improvements in both, urodynamic parameters and symptoms [67][68][69][70].…”

Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury

“…As a consequence, UTI have become one of the most frequent clinical problems in patients with NLUTD after SCI . If detrusor relaxation fails, bladder augmentation is the most frequently used surgical option to regain adequate bladder capacity and low intravesical pressure . Alternatively, reflex voiding after sphincterotomy may be considered in tetraplegic males.…”

A retrospective study on female urological surgeries over the 10 years following spinal cord lesion

“…The alternative option was ileocistoplasty augmentation, but none of them were willing to undergo more invasive surgery. 19,20 One more encouraging result of our study is that overall side effects correlated to surgeries were documented in few patients, and drawbacks were slight and transient.…”