Long-term results of augmentation cystoplasty in spinal cord injury patients

Abstract

Study design: Prospective monocentric follow-up study. Objectives: To assess long-term functional and urodynamic results of augmentation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperre¯exia and re¯ex incontinence who failed to respond to conservative treatment. Settings: Department of Urology (Pitie -Salpe trieÁ re Hospital, Paris, France), Department of Neurological Rehabilitation (Raymond Poincare Hospital, Garches, France), Assistance Publique ± Hopitaux de Paris, University Paris VI and V, France. Methods: Prospective study of 17 SCI patients (four above T6 level, nine between T6 and T12, and four below T12) with history of refractory urge incontinence to pharmacotherapy. Partial cystectomy (subtrigonal for 15) was performed with Hautmann enterocystoplasty (15) or detubularized clam cystoplasty (two). Results: Mean follow-up was 6.3+3.8 years (range 1.25 ± 10.5 years). Fifteen of 17 (88.5%) patients were completely continent under self clean intermittent catheterization (CIC) (mean 4.6/day, range 4 ± 7). The remaining two patients with pudendal nerve denervation had persistent stress urinary incontinence. No operative complications were noted. Long-term complications included recurrent pyelonephritis for one patient. Maximal cystometric capacity increased from 174.1+103.9 to 508.1+215.8 ml (P50.05). Maximal end ®lling pressure decreased from 65.5+50.2 to 18.3+7.9 cm H 2 O (P50.05). Conclusion: Urodynamic evaluation and clinical assessment demonstrate long-term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients. Spinal Cord (2000) 38, 490 ± 494

Outcomes of lower urinary and bowel function in meningomyelocele patients with augmentation enterocystoplasty

“…Augmentation enterocystoplasty is a procedure suitable for these MMC patients in whom conservative medical therapies have failed. 4,5 Although many papers revealed excellent clinical results of augmentation enteroplasty in patients with neurogenic bladder refractory to conservative therapies, [4][5][6][7] there have been few studies describing urodynamic results of augmentation enterocystoplasty and long-term satisfaction with bowel and urinary condition at postsurgery. In fact, as augmentation enterocystoplasty involves the incorporation of a bowel segment into the bladder, MMC patients may suffer from unstable bowel function after the surgery despite of a significant improvement of urinary condition such as urinary incontinence and UTI.…”

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

“…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.…”

A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra

“…This choice and the choice of an ileal detubularized segment to build the ECP were supported by the long-term successful outcomes we obtained with this technique in SCI patients. 3 All except one of our female patients had a history of prolonged indwelling urethral catheter. Subsequent urethral and bladder neck damage could explain the frequency of mixed urinary incontinence, low MUP or the opening bladder neck we observed.…”

“…When validated conservative treatment of neurogenic detrusor overactivity fails, enterocystoplasty (ECP) has been demonstrated to be a safe and effective alternative. 3,4 However, urethral catheterization can be impossible or unacceptable in some SCI patients. Upper limb dysfunction, difficulty in transferring or undressing oneself, inability to reach the urethra, or urethral lesions are the usual reasons that an SCI patient is unable to catheterize.…”