title: Prerequisite for successful surgical outcome in urothelium lined seromuscular colocystoplasty.
abstract: OBJECTIVE
  Urothelium lined seromuscular colocystoplasty is an ideal method of augmentation cystoplasty that avoids various complications caused by the use of gastrointestinal segments. We reviewed the long-term outcomes using this technique at a single institution.
  
  
  METHODS
  We retrospectively analyzed 34 patients who underwent urothelium lined seromuscular colocystoplasty between January 1996 and December 2007. A total of 33 patients, excluding 1 who had previously undergone artificial urinary sphincter implantation, were included in the study. Changes in urodynamic parameters, duration of anticholinergic use, incontinence and surgical complications were analyzed.
  
  
  RESULTS
  Mean±SD age at surgery was 10.0±5.7 years (range 3.0 to 26.0) and duration of followup was 6.0±2.3 years (2.7 to 13.4). A total of 17 patients (51.5%) underwent simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty. Mean bladder capacity increased by a factor of 2.96 and mean percentage of expected bladder capacity for age increased by a factor of 1.96 postoperatively. Of patients who underwent anti-incontinence surgery 4 of 10 whose abdominal leak point pressure was less than 40 cm H2O required additional surgery, whereas none whose abdominal leak point pressure was 40 to 60 cm H2O required reoperation. Two of 16 patients who did not undergo anti-incontinence surgery eventually required continence surgery. A total of 13 patients (39.4%) were able to discontinue anticholinergics at 47.3 months postoperatively. There were no bladder perforations, bowel obstructions or metabolic abnormalities.
  
  
  CONCLUSIONS
  Urothelium lined seromuscular colocystoplasty can be primarily considered in patients without prior bladder mucosal injury. Constant high bladder outlet pressure to facilitate adhesion of bladder mucosa and seromuscular patch is critical for the best results. We recommend abdominal leak point pressure 60 cm H2O or less as an indication for simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jung
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Lee
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.forename: Yong Seung
authors.initials: YS
authors.lastname: Lee
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Hong
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009130:Muscle, Smooth / Q000601:surgery*; D012074:Remission Induction; D012189:Retrospective Studies; D012704:Serous Membrane; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods*; D019459:Urothelium / Q000601:surgery*; D055815:Young Adult