Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty.
The clinical and urodynamic results of enterocystoplasty were compared in 3 groups of patients in which the intact ileocecal segment (10 patients), tubular sigmoid segment (16) or sigmoid cup-patch segment (8) was used. In all 3 groups the upper urinary tract and renal function improved or remained stable, and the functional bladder capacity increased. All patients experienced involuntary, volume-dependent vesical contractions of comparable intensity 3 months postoperatively. After a mean followup of 19.4 +/- 8.9 months only 12 per cent of the patients with a cup-patch configuration demonstrated volume-dependent contractions, compared to all patients with ileocecal cystoplasty and 94 per cent with sigmoid tubular cystoplasty. The intensity of these contractions was significantly less in the cup-patch configuration group compared to the other groups. Patients with cup-patch cystoplasty achieved a significantly higher rate of urinary continence than those in the other 2 groups. It appears that the sigmoid cup-patch configuration may provide a lower pressure system and better continence compared to the intact ileocecal or tubular sigmoid segment, although the latter techniques have specific applications when confronted with a wide gap between the ureters and bladder or when dilated ureters require anastomosis to the bowel.
D000293:Adolescent; D000328:Adult; D002432:Cecum / Q000637:transplantation; D012809:Colon, Sigmoid / Q000637:transplantation; D003556:Cystitis / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000637:transplantation; D007422:Intestines / Q000637:transplantation*; D008722:Methods; D009119:Muscle Contraction; D011183:Postoperative Complications; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000601:surgery; D014547:Urinary Diversion; D014549:Urinary Incontinence / Q000503:physiopathology; D014563:Urodynamics