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

Abstract

Prospective monocentric follow-up study. To assess long-term functional and urodynamic results of augmentation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperreflexia and reflex incontinence who failed to respond to conservative treatment. Department of Urology (Pitié-Salpétrière Hospital, Paris, France), Department of Neurological Rehabilitation (Raymond Poincaré Hospital, Garches, France), Assistance Publique - Hopitaux de Paris, University Paris VI and V, France. 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). 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 (P<0.05). Maximal end filling pressure decreased from 65.5+/-50.2 to 18.3+/-7.9 cm H2O (P<0.05). Urodynamic evaluation and clinical assessment demonstrate long-term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients.