Bladder augmentation using the gastrointestinal tract. Indication, follow up and complications.
The purpose of bladder augmentation using the gastrointestinal tract is to create a low-pressure and high-capacity reservoir, permitting suitable continence and voiding, preserving the upper urinary tract.


OBJECTIVE
To analyze the indications, complications and results of our series of augmentation enterocystoplasties.


METHODS
We retrospectively reviewed patients undergoing augmentation enterocystoplasty in our department between 1997 and 2010, both included. The indications were: Interstitial cystitis, neurogenic bladder and inflammatory bladder retraction. In all cases a cystography, urethrocystoscopy, urodynamic study and studies of each condition. Bladder release is performed by means of medial laparotomy and an extraperitoneal approach with bivalve opening to the urethral orifices. The bladder augmentation is performed with a 15-20 cm segment of detubularized ileum obtained at 20 cm from the ileocecal valve; in cases of kidney failure, a 7-cm gastric body wedge is added. The bladder catheter was removed following cystogram after 15 days. Monitoring was performed by means of ultrasound with postvoid residual, blood analyses, urine culture and voiding diary. We performed a descriptive study of the demographic characteristics, postoperative complications according to the Clavien classification and in the long term.


RESULTS
We included 24 patients, 19 women and 5 men with a mean age of 48.5 years and a median of 47 (21-77). Mean follow up was 7.5 years with a median of 8 (1-11). The indications were: 7 interstitial cystitis, 8 bladder retraction and 7 neurogenic bladder. There were no intraoperative complications. The postoperative complications were 3 Clavien I, 2 type II, 2 IIIA and 1 IIIB. In the long term, 3 patients presented urinary incontinence, 2 mild metabolic acidosis, 5 required self-catheterization, 6 bladder stones, 2 febrile urinary tract infections and 1 stricture of the anastomotic mouth. In three cases, an ileogastrocystoplasty was performed without hydroelectrolytic impairment or impairment of kidney function.


CONCLUSIONS
In selected patients, augmentation enterocystoplasty constitutes an efficacious therapeutic option in the treatment of lower urinary tract dysfunction with scant morbidity and few complications.
Urology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain. robersescu@hotmail.com
R Molina
RM
Escudero
G Escribano
GE
Patiño
E Rodríguez
ER
Fernández
M J Cancho
MJ
Gil
E Lledó
EL
García
A Husillos
AH
Alonso
G Ogaya
GO
Piniés
J Piñeiro
JP
Sánchez
C Hernández
CH
Fernández
D000138:Acidosis / Q000209:etiology; D000328:Adult; D000368:Aged; D018856:Cystitis, Interstitial / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000637:transplantation; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D001744:Urinary Bladder Calculi / Q000209:etiology; D001745:Urinary Bladder Diseases / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult