Abstract
ObjectivesTo report the long-term efficacy and complications of the augmentation uretero-enterocystoplasty (AUEC), including augmentation cystoplasty with simultaneous ureteroplasty and ureteral anti-reflux implantation in a single center.MethodsWe retrospectively reviewed clinical records, video-urodynamic data, and magnetic resonance urography of 210 patients who underwent the procedure for refractory lower urinary tract dysfunction (LUTD) from 2003 to 2019. International vesicoureteral reflux (VUR) and upper urinary tract dilatation (UUTD) grading systems were applied to assess upper urinary tract function, and post-operative complications were assessed.ResultsMean age was 28.1 years, with a mean follow-up time of 57.4 months. A total of 338 ureters were simultaneously re-implanted, and ureteroplasty was performed on all ureters. There was a significant postoperative improvement in the bladder capacity, intravesical pressure, and compliance (P < 0.05). VUR improvement rate was 97.7% and postoperative improvement of UUTD presented in 72.5% ureters. Mean serum creatinine (Scr) level was significantly improved compared to preoperative Scr values (226.0 ± 89.4 μmol/L vs. 217.5 ± 133.9 umol/L, P < 0.05). The 1.0% patients had unacceptably postoperative urinary incontinence and 85.4% preoperative megaureters were improved. Primary complications included metabolic acidosis (9.5%), vesicoureteral anastomosis stenosis (6.2%), persistent VUR (2.7%), urinary calculi (6.6%), and intestinal dysfunction requiring laparotomy (3.3%).ConclusionIn the study, a large series of patients treated with a complex surgical procedure was reported. It is novel, as this case series represents patients with aggressive surgical correction of VUR, ureteral tortuosity and upper tract dilation at the time of AC. AUEC was shown to have a positive role in treating patients with refractory LUTD associated with hydronephrosis and ureteral dilatation, stenosis or obstruction, with or without high- or low-pressure VUR. It was effective in improving renal function and protecting the UUT function from further deterioration in most patients with renal insufficiency.
Highlights
Augmentation cystoplasty (AC) was firstly performed in an experimental dog with ileum at the end of 19th century, it was applied to the patients with neurogenic bladders and small tuberculous bladders [1]
High intravesical pressure may result in vesicoureteral reflux (VUR), which is an important factor for upper urinary tract dilatation (UUTD), pyelonephritis, renal scarring, and renal deterioration [5]
Ureteral dilatation and hydronephrosis was evaluated according to magnetic resonance urography (MRU)-UUTD system described by Liao [10, 11] and VUR was graded with the international grading system for vesicoureteral reflux [12]
Summary
Augmentation cystoplasty (AC) was firstly performed in an experimental dog with ileum at the end of 19th century, it was applied to the patients with neurogenic bladders and small tuberculous bladders [1]. Surgical techniques have been described in patients and animals with lower urinary tract dysfunction (LUTD) in recent decades [3]. High intravesical pressure may result in vesicoureteral reflux (VUR), which is an important factor for upper urinary tract dilatation (UUTD), pyelonephritis, renal scarring, and renal deterioration [5]. It was indicated that more than 50% patients with high-grade VUR (grades III–V) underwent AC without simultaneous URI had residual high-grade VUR [6]. VUR initiated at lower intravesical pressure was suggested to be corrected concomitantly during AC as well [7]. Other studies have shown that performing AC alone could resolved VUR in most patients, URI is unnecessary [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
