title: Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow-up.
abstract: OBJECTIVE
  To report the long-term outcomes of augmentation ileocystoplasty (AIC) in patients with spinal cord injury (SCI), with a minimum follow-up period of 10 years.
  
  
  METHODS
  We retrospectively analysed all operations performed by a single surgeon at a specialist spinal unit. Outcomes were measured by comparing preoperative and follow-up videocystometrograms (VCMGs). Complications were identified from case notes and the surgery database. Subjective assessment was through a previously validated questionnaire.
  
  
  RESULTS
  The mean (range) follow-up was 14.7 (10.5-20.3) years. There were 19 patients (12 males) with a mean (range) age at time of surgery of 28.9 (12-52) years. The mean (range) period from injury to surgery was 4.5 (0.3-22) years. All had suprasacral injuries. The VCMGs showed a significant improvement in bladder capacity and a decrease in intravesical pressures (P < 0.001). Long-term complications included bladder stones (n= 4); urosepsis (n= 2); vesico-ureteric reflux ([VUR]n= 2), VUR requiring ureteric re-implantation (n= 1); neurogenic detrusor overactivity ([NDO]n= 1); and laparatomy for bowel obstruction (n= 1). Surveillance cystoscopies did not detect any bladder neoplasms. The response rate for the questionnaire survey was 14/17; 13/14 patients were satisfied with the operation such that they would consider it again or recommend it to a friend. No patient reported any significant changes in either bowel habit or sexual function.
  
  
  CONCLUSIONS
  We found that AIC has excellent long-term outcomes in the definitive management of refractory NDO in patients with SCI. The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients.
authors.affiliation: Institute of Urology, Division of Surgery and Interventional Science, University College London, UK. p.gurung@ucl.ac.uk
authors.forename: Pratik M S
authors.initials: PM
authors.lastname: Gurung
authors.forename: Kaka H
authors.initials: KH
authors.lastname: Attar
authors.forename: Ahmad
authors.initials: A
authors.lastname: Abdul-Rahman
authors.forename: Tim
authors.initials: T
authors.lastname: Morris
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.forename: P Julian R
authors.initials: PJ
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D053201:Urinary Bladder, Overactive / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult