Medium Term Results of Seromuscular Colocystoplasty Lined with Urothelium

Abstract

Purpose SCLU is an alternative to conventional augmentation to avoid incorporating intestinal mucosa into the urinary tract. Here we analyse the determinants of success and failure in 20 patients operated at 3 institutions. Material and Methods Institutional approved retrospective chart review of all patients who underwent SCLU in Wilmington, Salzburg and Zurich since 1998. Pre-and postoperative bladder capacity (BC) at 30 cm of water expressed in percentage of expected capacity for age (BC in ml = age + 1x30), prior, concomitant and subsequent bladder or bladder neck procedures, continence and need for re-augmentation was recorded. Results Twenty patients with neuropathic bladder, mean age 9 years, mean follow-up 53 months. An artificial urinary sphincter (AUS) was implanted at the time of SCLU in 10 patients, prior in 6, and after in 1. A sling was used in 3. G1 (n = 15) had no concomitant procedure in the bladder; G2 (n = 5) had simultaneous creation of a continent channel (CC). G1 BC increased from 60 % of expected for age to 100%. All patients are continent, none reaugmented. Of the 5 patients in G2, 3 required re-augmentation, 1 has stenosis of the CC and one is continent and using the CC without problems. Conclusions SCLU and AUS or sling is effective to augment the bladder. An intact bladder mucosa and early postoperative distention appear important for success. We have not been consistently successful in creating a CC at the time of SCLU and for patients who need it we recommend doing it at a later stage.