title: Use of an inflatable silicone balloon improves the success rate of bladder autoaugmentation at long-term followup.
abstract: OBJECTIVE
  Most groups have reported disappointing results with autoaugmentation or detrusor myectomy for low capacity/compliance neuropathic bladders. Failure may be due to an ischemic diverticulum or mucosal shrinkage. We investigated whether a Silimed® silicone balloon placed in the bladder after autoaugmentation could prevent these problems, improving surgical results.
  
  
  METHODS
  We compared the results of standard bladder autoaugmentation in 12 children (group 1) with those in 10 (group 2) who underwent the same surgery using a bladder conformer. The conformer was a silicone balloon filled with saline that remained in the bladder for 2 weeks. All patients had a neuropathic bladder with poor capacity and compliance, resulting in urinary leakage between catheterizations. Preoperative and postoperative evaluation included a voiding diary, ultrasound, voiding cystourethrogram and urodynamics.
  
  
  RESULTS
  In group 1 only 1 patient became dry, 4 had little improvement in continence, 4 remained unchanged and 3 became worse. In group 2, 6 patients (60%) become continent without medication, 2 (20%) become continent with oxybutynin and 2 remained unchanged. Bladder capacity and compliance did not change significantly in group 1. However, in group 2 capacity changed from a mean of 140 to 240 ml and mean ± SD compliance increased from 15.6 ± 16.8 to 34.3 ± 22.8 ml/cm H(2)O (p = 0.02).
  
  
  CONCLUSIONS
  The inflatable balloon improved our long-term results of bladder auto-augmentation. A larger series may be necessary to confirm procedure efficacy and safety.
authors.affiliation: Division of Urology, School of Medicine, São Paulo University, São Paulo, Brazil. flaviotrigo@uol.com.br
authors.forename: Flavio Trigo
authors.initials: FT
authors.lastname: Rocha
authors.forename: Homero
authors.initials: H
authors.lastname: Bruschini
authors.forename: José Alaor
authors.initials: JA
authors.lastname: Figueiredo
authors.forename: Marcos Gianetti
authors.initials: MG
authors.lastname: Machado
authors.forename: Cristiano Mendes
authors.initials: CM
authors.lastname: Gomes
authors.forename: Frederico
authors.initials: F
authors.lastname: Mascarenhas
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000295:instrumentation; D002648:Child; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D012828:Silicones; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*
chemical_list: D012828:Silicones