Augmentation cystoplasty in patients with multiple sclerosis.
BACKGROUND
Augmentation cystoplasty is an effective approach to the detrusor hyperreflexia which is refractory to conservative treatment. Sporadic data have been published in patients with progressive diseases such as multiple sclerosis (MS).


METHODS
Augmentation ileocystoplasty (Goodwin 'cup-patch') was performed in 9 patients (7 females, 2 males). The average Expanded Disability Status Scale score was 4.1 (range 3.0-6.5); 7 patients had relapse-remitting MS and 2 patients secondary-progressive MS. The indication was a detrusor hyperreflexia refractory to conservative treatment in 8 patients and a detrusor hyperrefluxia with third degree bilateral vesico-ureteral reflux and renal insufficiency in 1 patient. Pre- and postoperative objective parameters were evaluated by urodynamic examination, imaging methods and laboratory examination. Subjective evaluation was performed using a questionnaire on micturition symptoms (score 0-5) and on quality of life (score 0-6).


RESULTS
With a follow-up of 6-19 months, we recorded an average increase of the maximum detrusor capacity from 105 to 797 ml and decrease of maximum detrusor pressure from 53 to 30 cm H(2)O. Postmicturition residual urine >25% of the maximum capacity was present in 6 patients who performed clear intermittent autocatheterization postoperatively (2 patients preoperatively). In all patients there was a significant improvement in the irritation micturition symptomatology (pollakisuria, nycturia, urgency and urge incontinence) and the quality of life score improved on average from 5 to 0.7. In the case of the patient with renal insufficiency, the creatinine level decreased from 286 to 150 micromol/l; in the other patients renal function remained normal.


CONCLUSIONS
Augmentation cystoplasty is a safe and effective method for indicated patients, which significantly enhances their quality of life.
Zachoval
Roman
R
Department of Urology, 3rd Faculty Hospital, Charles University, Prague, Czech Republic. zachoval@fnkv.cz
Pitha
Jiri
J
Medova
Eva
E
Heracek
Jiri
J
Lukes
Martin
M
Zalesky
Miroslav
M
Urban
Michael
M
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis; D011446:Prospective Studies; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000601:surgery