title: Comparison of extraperitoneal and intraperitoneal augmentation enterocystoplasty for neurogenic bladder in spinal cord injury patients.
abstract: OBJECTIVE
  Augmentation enterocystoplasty is the standard treatment for patients with neurogenic bladder who have failed medical management. Our "extraperitoneal" approach involves a small peritoneotomy to obtain the segment of bowel for augmentation, and a standard "clam" enterocystoplasty. We compared operative and postoperative parameters and clinical outcomes of this technique with the standard intraperitoneal technique.
  
  
  METHODS
  We retrospectively reviewed charts of 73 patients with neurogenic voiding dysfunction refractory to medical management who underwent augmentation enterocystoplasty alone or in conjunction with additional procedures. A total of 49 patients underwent extraperitoneal augmentation and 24 patients underwent intraperitoneal augmentation. Operative and postoperative parameters including time of surgery, estimated blood loss, need for blood transfusion, time for return of bowel function, and length of hospital stay were examined. Clinical outcomes including early and late postoperative complications, and continence status were also analyzed.
  
  
  RESULTS
  Median follow-up was 2.5 years. Patients in the extraperitoneal group had significantly shorter operative time (3.9 vs. 5.6 h, P < 0.0001); shorter hospital stay (8.0 vs. 10.5 days, P = 0.009); and shorter time to return of bowel function (3.5 vs. 4.9 days, P = 0.0005). There was no significant difference in complication rates. Postoperative continence was equally improved in both groups. When only patients with no prior abdominal surgery were compared, the findings were analogous: shorter operative time, shorter length of stay, sooner return of bowel function, and no difference in complication rate.
  
  
  CONCLUSIONS
  The extraperitoneal technique provides an equally effective method of bladder augmentation to the standard technique with easier early postoperative recovery.
authors.affiliation: Department of Urology, Keck School of Medicine, University of Southern California, Rancho Los Amigos National Rehabilitation Center, Los Angeles, California, USA.
authors.forename: Polina
authors.initials: P
authors.lastname: Reyblat
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Chan
authors.forename: David Y
authors.initials: DY
authors.lastname: Josephson
authors.forename: John P
authors.initials: JP
authors.lastname: Stein
authors.forename: John A
authors.initials: JA
authors.lastname: Freeman
authors.forename: Gary D
authors.initials: GD
authors.lastname: Grossfeld
authors.forename: David
authors.initials: D
authors.lastname: Esrig
authors.forename: David A
authors.initials: DA
authors.lastname: Ginsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008875:Middle Aged; D010537:Peritoneum; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult