title: The problems of substitution cystoplasty.
abstract: Substitution cystoplasty was performed in 157 patients aged 4 to 71 years; 62% suffered no post-operative complication. The commonest complication was sphincter-weakness incontinence, found in 18%, mainly in patients having a cystoplasty for interstitial cystitis; it was rare for the patient to complain of this incontinence. Ten per cent suffered incontinence due to colonic overactivity and this occurred in patients with neuropathic sphincter-weakness incontinence or an artificial sphincter; all of these patients complained of their incontinence. This was corrected by "patching" in all cases. Voiding difficulties requiring clean intermittent self-catheterisation occurred in 15%. More worrying was the universal finding, when looked for by blood gas analysis, of a metabolic acidosis with respiratory compensation. It was concluded that in the absence of neuropathy, sphincter weakness or an artificial sphincter, an unmodified ileocaecal segment substitution cystoplasty is adequate; in the presence of neuropathy, sphincter weakness or an artificial sphincter, a "pouch" type of substitution cystoplasty should be performed. All patients should have blood gas analyses from time to time as part of their routine post-operative follow-up.
authors.affiliation: Department of Surgery, Guy's Hospital, London.
authors.forename: D E
authors.initials: DE
authors.lastname: Nurse
authors.forename: P
authors.initials: P
authors.lastname: McCrae
authors.forename: T P
authors.initials: TP
authors.lastname: Stephenson
authors.forename: A R
authors.initials: AR
authors.lastname: Mundy
mesh_terms: D000138:Acidosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology