Augmentation Enterocystoplasty: A Critical Review

Abstract

An over-all success rate of 58.1 per cent has been achieved in 74 patients who have undergone augmentation cystoplasty. Indications for the operation included a contracted bladder secondary to interstitial cystitis in 30 patients, defunctionalized bladder in 12, neurogenic bladder in 11, radiation cystitis in 9, tuberculous cystitis in 7, chemical cystitis in 4 and pericystitis in 1. Male patients did as well as female patients. Specific indications for the operation did not seem to influence success rate, although augmentation cystoplasty used as part of a planned undiversion had a significantly lower success rate (45 per cent) than when cystoplasty was used with an intact urinary tract (66.7 per cent). The segment of bowel used did not seem to influence results. Patients who underwent associated bladder neck revision seemed to do better, while no benefit was noted in patients who had a supratrigonal excision of the diseased detrusor. Complications were eliminated in 82 per cent of the patients, while only 3 patients had progressive uremia. Operative mortality occurred in 2 patients (2.7 per cent). Four other deaths have occurred in the entire series, IV2, 2, 5 and 11 years later. Contraindications to the operation include patients with azotemia, vesical neoplasm, neurogenic bladder with spastic pelvic floor and some cases of defunctionalized contracted bladders. The pre-adolescent boy may have difficulty in voiding because of mucus. Patients with a strong psychiatric history should be approached with caution.