title: Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction.
abstract: OBJECTIVE
  To investigate the functional outcome after supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction (NLUTD).
  
  
  METHODS
  Retrospective follow-up investigation in a single spinal cord injury rehabilitation center. In 29 patients, urodynamic data before and after supratrigonal cystectomy and augmentation ileocystoplasty, clinical outcome and post-operative complications were evaluated.
  
  
  RESULTS
  The median age of the 29 patients at the time of surgery was 31 years, a median 14 years after NLUTD had occurred. At the last follow-up visit (median 2.4, range 0.4-9.0 years post-operatively), 20/29 patients (69%) were continent compared to 2/29 pre-operatively (P = 0.001). Furthermore, 16 patients required no or less detrusor relaxation therapy after augmentation ileocystoplasty. Augmentation cystoplasty resulted in a significant (P = 0.001) increase in the median bladder capacity (from 240 ml to 500 ml) and compliance (from 13 ml/cm H2 O to 50 ml/cm H2 O). The median maximum detrusor pressure had decreased significantly (P = 0.001) from 38 cm H2 O to 15 cm H2 O. Significantly (P = 0.001) fewer patients presented with a risk for renal damage (1 vs. 15 with maximum detrusor pressure >40 cm H2 O and 1 vs. 12 with detrusor compliance <20 ml/cm H2 O) at the last follow-up. The following complications were observed in 11/29 (38%) patients: paralytic and obstructive ileus, impaired bowel function, bladder stones, dehiscence, metabolic acidosis and autonomic dysreflexia.
  
  
  CONCLUSIONS
  Protection of renal function, adequate bladder capacity and low detrusor pressure can be achieved using supratrigonal cystectomy and augmentation ileocystoplasty in patients suffering from refractory NLUTD.
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Jörg
authors.initials: J
authors.lastname: Krebs
authors.affiliation: Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Bartel
authors.affiliation: Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
mesh_terms: D000293:Adolescent; D000328:Adult; D003187:Compliance; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D055815:Young Adult
keywords: augmentation ileocystoplasty; complications; neurogenic lower urinary tract dysfunction; urinary continence; urodynamics