Cystoplasty Augmentation Using Small Intestinal Submucosa for Treatment of Refractory Bladder Dysfunction and Comparison with Augmentation Enterocystoplasty for Patients With Neurogenic Bladder
Dr Kexin Xu (1)
(1) Peking University People's hospital, Beijing, China
Bladder augmentation with enterocystoplasty is the most common therapy for the low volume and compliance bladder. There were many complications associated with the presence of gastrointestinal segments in the urinary tract. We reviewed the efficacy and availability after cystoplasty augmentation using small intestinal submucosa(SIS) for the poor capacity and compliance bladder.
MethodsWe selected 12 patients with poor bladder capacity and compliance who received SIS cystoplasty augmentation from 2015 to 2018. Candidate age ranged from 10 to 66 years. The refractory bladder dysfunction in this study was defined as a small bladder capacity and inadequate bladder compliance, and included 7 patients with neurogenic bladder, and 5 patients with refractory interstitial cystitis. Pre- and post-operative urodynamics, cystoscopy, voiding diary and serum analyses were recorded. Postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed.
The median follow up was 20 months (6-40 months). All patients had significantly increased cystometric bladder capacity and compliance at the time of follow-up. Two early postoperative complications (1 grade I, 1 grade IV) were observed in 2 patients (17%). No metabolic consequences or urinary calculi were observed after surgery. Creatinine clearance were improved or preserved postoperatively. At last follow up, the continence rate was 100% (n = 12), with 25% (n =3) performing intermittent self-catheterization. Quality of life was improved for 92% of patients.
SIS cystoplasty augmentation provides a viable option for bladder reconstruction in patients with small bladder capacity and inadequate bladder compliance.