Augmentation enterocystoplasty for urinary storage dysfunction in females

Abstract

Urinary incontinence resulting from impaired bladder storage abilities, which is unresponsive to conservative treatments, presents a therapeutic challenge. Carefully selected patients with neurogenic bladder dysfunction, a structurally or anatomically smallcapacity bladder, idiopathic bladder instability, and interstitial cystitis may benefit from augmentation enterocystoplasty. The preoperative evaluation should include a complete assessment of the urinary tract, renal function, and the continence mechanism, along with a careful assessment of urethral accessibility and patency and the patient's willingness and ability to perform lifelong intermittent self-catheterization. Although any segment of bowel is suitable for bladder augmentation, it is advisable to avoid the ileocecal segment in patients with neurogenic bladder dysfunction. The bowel segment should be detubularized and anastomosed to the widely spatulated bladder to avoid an hour-glass deformity. In the immediate postoperative period, patency of the catheter is maintained by frequent, gentle irrigations. Long-term follow-up is mandatory to monitor the chronic bacteriuria and because of the low incidence of spontaneous bladder perforation and carcinogenesis in the augmented bladder.