Long-term outcome of bladder augmentation for the treatment of hyperreflexia neurogenical bladder

Abstract

Objective To evaluate the long-term outcome of bladder augmentation using double de-epithelialized segment of the small intestine lined with urothelium for the treatment of hyperreflexia neurogenical bladder.Methods Seventy eight patients,who underwent electromyogram of pelvic floor and be diagnosed with bladder nerve dysfunction,were enrolled in this study.The causes for the bladder nerve dysfunction on these patients were tethered cord syndrome,meningomyelocele,and intraspinal lipoma.All the children had taken conservative treatments such as anticholinergic medicine treatment and clean intermittent catheterization for a long time without any improvement of bladder capacity or vesicoureteral reflux.The surgical indications of these patients were neurogenical bladder,four degree vesicoureteral reflux,and smaller bladder than norrnal bladder volume.They underwent to enterocystoplasty using de-epithelialized segment of the intestine lined with urothelium.Some patients underwent Cohen operation,Leadbetter operation or Marshall-Marchettitype operation.Patient's kidney function,Urodynamic and clinical evaluation were followed up.Results Sixty eight patients were followed up for a mean period of 3.5 years.No renal failure happened.Forty five patients had improvements in their conditions,whose bladder volume,compliance and detrusor pressure were (321.80±98.54)ml,(11.08±2.57)ml/cmH2O,(30.34±12.28)cmH2O,respectively;and the other 23 patients had no improvements after surgery.Conclusions Bladder augmentation using double deepithelialized segment of the small intestine lined with urothelium achieved good outcomes on some patients with hyperreflexia neurogenical bladder.Bladder volume enlargement after surgery is the prognostic factor for the long term outcome. Key words: Bladder,neurogenic; Urologic surgical procedures; Urodynamics