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Long-term follow-up of neurogenic bladder patients after bladder augmentation with small intestinal submucosa

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Abstract

Purpose

To evaluate the long-term effect of using small intestinal submucosa (SIS) for bladder augmentation in patients with neurogenic bladder.

Materials and methods

A total of 15 patients (age range 14–65 years; mean age 29.6 years) were enrolled in our study. The patients had poor bladder capacity and compliance caused by a neurogenic disorder requiring bladder augmentation. A small intestinal submucosa (SIS) cystoplasty was performed alone or in combination with ureter reimplantation. We prospectively followed the cohort to assess the urodynamics parameters, morphologic changes and patient satisfaction and evaluate the clinical benefit of the SIS procedure in long term. The surgical indications and complications were analyzed.

Results

The duration of follow-up ranged from 4.5 to 8.3 years (mean 6.3 years). Nine patients had expected long-term benefit, leading to an overall success rate of 60%. Two patients experienced immediate failure, and four patients slowed decrease in bladder capacity over time. Compared with the baseline data, there were significant increases in bladder capacity (163.5 ± 80.90–275.6 ± 159.5 ml, p < 0.05) and a significant decrease in maximum detrusor pressure (45.07 ± 29.03–17.60 ± 10.34 cmH2O, p < 0.05). Histologic examinations showed a complete conversion of SIS, leaving the urothelial lining and bladder wall containing muscular, vascular, and relatively thick connective tissue. Major complications included vesicoureteral reflux in five patients, bladder stone formation in one patient, and bladder perforation in one patient.

Conclusion

Bladder augmentation with an SIS graft offers a partial long-term success rate in neurogenic bladder patients. This procedure cannot be recommended as a substitute for enterocystoplasty, especially in patients with severe upper urinary tract deterioration and/or bladder fibrosis.

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Abbreviations

SIS:

Small intestinal submucosa

TE:

Tissue engineering

BA:

Bladder augmentation

VUDS:

Video-urodynamics

MBC:

Maximum bladder capacity

MDP:

Maximum detrusor pressure

BC:

Bladder compliance

VUR:

Vesicoureteric reflux

IC:

Intermittent catheterization

DO:

Detrusor overactivity

URI:

Ureter reimplantation

UTIs:

Urinary tract infections

UUT:

Upper urinary tract

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Acknowledgements

This study was supported by Grants from the National Natural Scientific Foundation of (no.81570688).

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Authors and Affiliations

  1. Department of Urology, Fengtai District, China Rehabilitation Research Center, 10 JiaomenBeilu, Beijing, 100068, China

    Fan Zhang & Limin Liao

  2. Department of Urology of Capital Medical University, Beijing, China

    Fan Zhang & Limin Liao

Authors
  1. Fan Zhang
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  2. Limin Liao
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Contributions

LL: project development, manuscript editing. FZ: data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Limin Liao.

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The authors declare that they have no conflict of interest.

Ethics approval

All protocols involving human participants in this study were approved by the Ethics Committee of Capital Medical University, China and had informed consent.

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Zhang, F., Liao, L. Long-term follow-up of neurogenic bladder patients after bladder augmentation with small intestinal submucosa. World J Urol 38, 2279–2288 (2020). https://doi.org/10.1007/s00345-019-03008-x

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  • DOI: https://doi.org/10.1007/s00345-019-03008-x

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