Single surgeon experience of augmentation ileocystoplasty in the management of refractory idiopathic detrusor overactivity

Abstract

Background: Until a decade ago, augmentation ileocystoplasty (AIC) was the only major advancement over anti-muscarinics for intractable idiopathic detrusor overactivity (IDO). Clam ileocystoplasty has been proposed to restore continence and preserve urethral voiding. While intravesical botulinum and neuromodulation have revolutionised the treatment of this condition, arguably there remains a place for bladder augmentation in the surgical armamentarium. Objective: This study presents a single surgeon experience of clam ileocystoplasty performed for intractable IDO at our institution. Methods: A retrospective case-note review was performed over a 9-year period. Data on basic patient demographics, urodynamic findings, pre-operative treatments administered, post-operative complications and response to surgery were documented. Results: In total, 22 patients were identified with a median age of 42.4 years. The predominant symptoms were urgency (100%) and urge incontinence (96%). All our patients were incontinent pre-operatively with 59% using pads. Ambulatory cystometry was helpful in 27% patients in whom standard +/- video studies were inconclusive. Of the cohort, 100%, 82% and 55% had one, two and three anticholinergics, respectively. Only 18% received intravesical botulinum toxin A pre-operatively. Some 77% were cured of their storage symptoms and incontinence; 18% had residual incontinence. Of these, genuine urodynamic stress incontinence was demonstrated in 9% and improved with tension-free vaginal tape. Some 9% had Clavien 3b complications requiring laparotomy. Mortality was nil. Conclusion: In young patients with refractory IDO, clam ileocystoplasty serves as a permanent, effective technique for symptom reduction and restoration of continent urethral voiding with few complications.