Surgical and patient reported outcomes of 'clam' augmentation ileocystoplasty in spinal cord injured patients.

Abstract

To study the outcomes and effectiveness of 'clam' augmentation ileocystoplasty in the treatment of suprasacral spinal cord injured patients with detrusor hyperreflexia refractory to pharmacological and other conservative therapy. A retrospective review of spinal injured patients who had undergone 'clam' augmentation ileocystoplasty was performed, followed by a specifically designed questionnaire/telephone interview to assess patient satisfaction and other issues from this specific group of patients with suprasacral spinal cord lesions. 32 patients were followed up for a mean of 6.0 +/- 3.6 years. Complete continence was found in all patients. There was a significant improvement in bladder capacity from a mean 143 +/- 81 ml pre-operatively to 589 +/- 188 ml post-operatively, and the maximum detrusor pressure fell from a mean of 108 +/- 43 cm H(2)O to 19 +/- 15 cm H(2)O. Pre-operative vesico-ureteric reflux resolved completely in 4 out of 5 patients and improved from grade IV to grade II in one, illustrating the need for achieving low bladder pressures rather than the performance of an anti-reflux procedure at the time of cystoplasty. The use of the questionnaire, designed to evaluate this subset of patients after augmentation cystoplasty, highlighted the high levels of satisfaction with the operation in this group of patients with 96.2% of patients reporting an improvement in quality of life parameters. Using an appropriate questionnaire we have found high satisfaction rates, in addition to successful surgical outcomes, in spinal cord injured patients following augmentation cystoplasty. We recommend using this questionnaire as part of the work-up and ongoing assessment of spinal injured patients undergoing 'clam' augmentation ileocystoplasty.