Abstract
Purpose
To review the indications and techniques of augmentation cystoplasty (AC) in patients with neurogenic bladder (NGB) while also examining the long-term outcomes, complications, and follow-up surgeries.
Methods
PubMed/MEDLINE, Cochrane Library, and Embase databases were searched for articles related to AC and NGB.
Results
AC is indicated for an overactive or poorly compliant bladder refractory to conservative therapies, such as anticholinergic medications and bladder botulinum toxin injections. A variety of surgical techniques using gastrointestinal segments, alternative tissues, and synthetic materials have been described, though bowel remains the most durable. Ileocystoplasty is the most common type of AC, which uses a detubularized patch of ileum that is anastomosed to a bivalved bladder. Some patients undergo concomitant surgeries at the time of AC, such as catheterizable channel creation to aid with clean intermittent catheterization, ureteral reimplantation to treat vesicoureteral reflux, and bladder outlet procedure to treat incontinence. Following AC, the majority of patients experience an improvement in bladder capacity, compliance, and continence. Most patients also experience an improvement in quality of life. AC has significant complications, such as chronic UTIs, bladder and renal calculi, metabolic disturbances, bowel problems, perforation, and malignancy. AC also has a high rate of follow-up surgeries, especially if the patient undergoes concomitant creation of a catheterizable channel.
Conclusions
Enterocystoplasty remains the gold standard for AC, though more research is needed to better evaluate the morbidity of different surgical techniques and the indications for concomitant surgeries. Experimental methods of AC with tissue engineering are a promising area for further investigation.
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References
Woodhouse CR (2005) Myelomeningocele in young adults. BJU Int 95(2):223–230. https://doi.org/10.1111/j.1464-410X.2005.05374.x
Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel D, Welk B, Neurogenic Bladder Research G (2019) The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization. Neurourol Urodyn 38(1):285–294. https://doi.org/10.1002/nau.23849
Dik P, Klijn AJ, van Gool JD, de Jong-de Vos van Steenwijk CC, de Jong TP (2006) Early start to therapy preserves kidney function in spina bifida patients. Eur Urol 49(5):908–913. https://doi.org/10.1016/j.eururo.2005.12.056
Ginsberg D, Gousse A, Keppenne V, Sievert KD, Thompson C, Lam W, Brin MF, Jenkins B, Haag-Molkenteller C (2012) Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol 187(6):2131–2139. https://doi.org/10.1016/j.juro.2012.01.125
Hendren WH (1975) Nonrefluxing colon conduit for temporary or permanent urinary diversion in children. J Pediatr Surg 10(3):381–398
Leadbetter WF, Shaffer FG (1956) Ileal loop diversion; its application to the treatment of neurogenic bladder dysfunction. J Urol 75(3):470–479
Husmann DA, McLorie GA, Churchill BM (1989) Nonrefluxing colonic conduits: a long-term life-table analysis. J Urol 142(5):1201–1203
Leong CH, Ong GB (1975) Proceedings: gastrocystoplasty. Br J Urol 47(2):236
Smith RB, van Cangh P, Skinner DG, Kaufman JJ, Goodwin WE (1977) Augmentation enterocystoplasty: a critical review. J Urol 118(1 Pt 1):35–39
Quek ML, Ginsberg DA (2003) Long-term urodynamics followup of bladder augmentation for neurogenic bladder. J Urol 169(1):195–198. https://doi.org/10.1097/01.ju.0000039782.13395.0a
Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, t’Hoen L, Blok B (2016) Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 69(2):324–333. https://doi.org/10.1016/j.eururo.2015.07.071
Khastgir J, Hamid R, Arya M, Shah N, Shah PJ (2003) Surgical and patient reported outcomes of ‘clam’ augmentation ileocystoplasty in spinal cord injured patients. Eur Urol 43(3):263–269
Zachoval R, Pitha J, Medova E, Heracek J, Lukes M, Zalesky M, Urban M (2003) Augmentation cystoplasty in patients with multiple sclerosis. Urol Int 70(1):21–26. https://doi.org/10.1159/000067708(discussion 26)
Biers SM, Venn SN, Greenwell TJ (2012) The past, present and future of augmentation cystoplasty. BJU Int 109(9):1280–1293. https://doi.org/10.1111/j.1464-410X.2011.10650.x
Roth JD, Cain MP (2018) Neuropathic bladder and augmentation cystoplasty. Urol Clin N Am 45(4):571–585. https://doi.org/10.1016/j.ucl.2018.06.005
Hayashi Y, Nishimura E, Shimizu S, Miyano G, Okawada M, Nagae I, Lane GJ, Katsumata K, Yamataka A, Tsuchida A (2017) Sigmoidocolocystoplasty for neurogenic bladder reviewed after 20 years. J Pediatr Surg 52(12):2070–2073. https://doi.org/10.1016/j.jpedsurg.2017.08.029
Mundy AR, Stephenson TP (1985) “Clam” ileocystoplasty for the treatment of refractory urge incontinence. Br J Urol 57(6):641–646
Castellan M, Gosalbez R, Bar-Yosef Y, Labbie A (2012) Complications after use of gastric segments for lower urinary tract reconstruction. J Urol 187(5):1823–1827. https://doi.org/10.1016/j.juro.2011.12.105
Chadwick Plaire J, Snodgrass WT, Grady RW, Mitchell ME (2000) Long-term followup of the hematuria–dysuria syndrome. J Urol 164(3 Pt 2):921–923
Nguyen DH, Bain MA, Salmonson KL, Ganesan GS, Burns MW, Mitchell ME (1993) The syndrome of dysuria and hematuria in pediatric urinary reconstruction with stomach. J Urol 150(2 Pt 2):707–709
Vemulakonda VM, Lendvay TS, Shnorhavorian M, Joyner BD, Kaplan H, Mitchell ME, Grady RW (2008) Metastatic adenocarcinoma after augmentation gastrocystoplasty. J Urol 179(3):1094–1096. https://doi.org/10.1016/j.juro.2007.10.089(discussion 1097)
Gold BD, Bhoopalam PS, Reifen RM, Harvey E, Marcon MA (1992) Gastrointestinal complications of gastrocystoplasty. Arch Dis Child 67(10):1272–1276
Plawker MW, Rabinowitz SS, Etwaru DJ, Glassberg KI (1995) Hypergastrinemia, dysuria-hematuria and metabolic alkalosis: complications associated with gastrocystoplasty. J Urol 154(2 Pt 1):546–549
Reinberg Y, Manivel JC, Froemming C, Gonzalez R (1992) Perforation of the gastric segment of an augmented bladder secondary to peptic ulcer disease. J Urol 148(2 Pt 1):369–371
Wang K, Yamataka A, Morioka A, Lane GJ, Iwashita K, Miyano T (1999) Complications after sigmoidocolocystoplasty: review of 100 cases at one institution. J Pediatr Surg 34(11):1672–1677
Hendren WH, Hendren RB (1990) Bladder augmentation: experience with 129 children and young adults. J Urol 144(2 Pt 2):445–453 (discussion 460)
Murray K, Nurse DE, Mundy AR (1987) Secreto-motor function of intestinal segments used in lower urinary tract reconstruction. Br J Urol 60(6):532–535
Radomski SB, Herschorn S, Stone AR (1995) Urodynamic comparison of ileum vs. sigmoid in augmentation cystoplasty for neurogenic bladder dysfunction. Neurourol Urodyn 14(3):231–237
Sidi AA, Reinberg Y, Gonzalez R (1986) Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty. J Urol 136(6):1201–1204
Whitmore WF 3rd, Gittes RF (1983) Reconstruction of the urinary tract by cecal and ileocecal cystoplasty: review of a 15-year experience. J Urol 129(3):494–498
Sarosdy MF (1992) Continent urinary diversion using cutaneous ileocecocystoplasty. Urology 40(2):102–106
Khavari R, Fletcher SG, Liu J, Boone TB (2012) A modification to augmentation cystoplasty with catheterizable stoma for neurogenic patients: technique and long-term results. Urology 80(2):460–464. https://doi.org/10.1016/j.urology.2012.03.038
Cartwright PC, Snow BW (1989) Bladder autoaugmentation: partial detrusor excision to augment the bladder without use of bowel. J Urol 142(4):1050–1053
MacNeily AE, Afshar K, Coleman GU, Johnson HW (2003) Autoaugmentation by detrusor myotomy: its lack of effectiveness in the management of congenital neuropathic bladder. J Urol 170(4 Pt 2):1643–1646. https://doi.org/10.1097/01.ju.0000083800.25112.22(discussion 1646)
Snow BW, Cartwright PC (1992) Autoaugmentation of the bladder. Contemp Urol 4(7):41–51
Johal NS, Hamid R, Aslam Z, Carr B, Cuckow PM, Duffy PG (2008) Ureterocystoplasty: long-term functional results. J Urol 179(6):2373–2375. https://doi.org/10.1016/j.juro.2008.01.170(discussion 2376)
Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB (2006) Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet 367(9518):1241–1246. https://doi.org/10.1016/S0140-6736(06)68438-9
Elbahnasy AM, Shalhav A, Hoenig DM, Figenshau R, Clayman RV (1998) Bladder wall substitution with synthetic and non-intestinal organic materials. J Urol 159(3):628–637
Salehipour M, Mohammadian R, Malekahmadi A, Hosseinzadeh M, Yadollahi M, Natami M, Mohammadian M (2016) Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial? Int Braz J Urol 42(2):383–388. https://doi.org/10.1590/S1677-5538.IBJU.2014.0680
Lin HK, Madihally SV, Palmer B, Frimberger D, Fung KM, Kropp BP (2015) Biomatrices for bladder reconstruction. Adv Drug Deliv Rev 82–83:47–63. https://doi.org/10.1016/j.addr.2014.11.020
Affas S, Schafer FM, Algarrahi K, Cristofaro V, Sullivan MP, Yang X, Costa K, Sack B, Gharaee-Kermani M, Macoska JA, Gundogdu G, Seager C, Estrada CR Jr, Mauney JR (2018) Augmentation cystoplasty of diseased porcine bladders with bi-layer silk fibroin grafts. Tissue Eng Part A. https://doi.org/10.1089/ten.TEA.2018.0113
Leonhauser D, Stollenwerk K, Seifarth V, Zraik IM, Vogt M, Srinivasan PK, Tolba RH, Grosse JO (2017) Two differentially structured collagen scaffolds for potential urinary bladder augmentation: proof of concept study in a Gottingen minipig model. J Transl Med 15(1):3. https://doi.org/10.1186/s12967-016-1112-5
Song L, Murphy SV, Yang B, Xu Y, Zhang Y, Atala A (2014) Bladder acellular matrix and its application in bladder augmentation. Tissue Eng Part B Rev 20(2):163–172. https://doi.org/10.1089/ten.TEB.2013.0103
Zhe Z, Jun D, Yang Z, Mingxi X, Ke Z, Ming Z, Zhong W, Mujun L (2016) Bladder acellular matrix grafts seeded with adipose-derived stem cells and incubated intraperitoneally promote the regeneration of bladder smooth muscle and nerve in a rat model of bladder augmentation. Stem Cells Dev 25(5):405–414. https://doi.org/10.1089/scd.2015.0246
Gill IS, Rackley RR, Meraney AM, Marcello PW, Sung GT (2000) Laparoscopic enterocystoplasty. Urology 55(2):178–181
Elliott SP, Meng MV, Anwar HP, Stoller ML (2002) Complete laparoscopic ileal cystoplasty. Urology 59(6):939–943
Cohen AJ, Brodie K, Murthy P, Wilcox DT, Gundeti MS (2016) Comparative outcomes and perioperative complications of robotic vs open cystoplasty and complex reconstructions. Urology 97:172–178. https://doi.org/10.1016/j.urology.2016.06.053
Redshaw JD, Elliott SP, Rosenstein DI, Erickson BA, Presson AP, Conti SL, McAdams S, Nguyen A, West JM, Brant WO, Myers JB (2014) Procedures needed to maintain functionality of adult continent catheterizable channels: a comparison of continent cutaneous ileal cecocystoplasty with tunneled catheterizable channels. J Urol 192(3):821–826. https://doi.org/10.1016/j.juro.2014.03.088
Soylet Y, Emir H, Ilce Z, Yesildag E, Buyukunal SN, Danismend N (2004) Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty. BJU Int 94(3):379–380. https://doi.org/10.1111/j.1464-410X.2004.04965.x
Zhang HC, Yang J, Ye X, Hu HF (2016) Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux. Kaohsiung J Med Sci 32(6):323–326. https://doi.org/10.1016/j.kjms.2016.05.003
Wang JB, Liu CS, Tsai SL, Wei CF, Chin TW (2011) Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder. J Chin Med Assoc 74(7):294–297. https://doi.org/10.1016/j.jcma.2011.05.004
Wang Z, Liao L (2018) Effectiveness and complications of augmentation cystoplasty with or without nonrefluxing ureteral reimplantation in patients with bladder dysfunction: a single center 11-year experience. J Urol 199(1):200–205. https://doi.org/10.1016/j.juro.2017.07.073
Apostolidis A, Drake MJ, Emmanuel A, Gajewski JB, Hamid R, Heesakkers JP, Kessler T, Madersbacher H, Radziszewski P, Sakakibara R, Sievert KD, Wyndaele JJ (2017) Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A (eds) incontinence, 6th edn. International Continence Society, Bristol, pp 1093–1308
Lee HE, Bae J, Oh JK, Oh SJ (2013) Is concomitant bladder neck reconstruction necessary in neurogenic incontinent patients who undergo augmentation cystoplasty? Korean J Urol 54(1):42–47. https://doi.org/10.4111/kju.2013.54.1.42
Khoury AE, Dave S, Peralta-Del Valle MH, Braga LH, Lorenzo AJ, Bagli D (2008) Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder. BJU Int 101(2):223–226. https://doi.org/10.1111/j.1464-410X.2007.07164.x
Myers JB, Mayer EN, Lenherr S, Neurogenic Bladder Research G (2016) Management options for sphincteric deficiency in adults with neurogenic bladder. Transl Androl Urol 5(1):145–157. https://doi.org/10.3978/j.issn.2223-4683.2015.12.11
Herschorn S, Hewitt RJ (1998) Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder. Urology 52(4):672–678
Hoen L, Ecclestone H, Blok BFM, Karsenty G, Phe V, Bossier R, Groen J, Castro-Diaz D, Padilla Fernandez B, Del Popolo G, Musco S, Pannek J, Kessler TM, Gross T, Schneider MP, Hamid R (2017) Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: a systematic review. Neurourol Urodyn 36(7):1685–1702. https://doi.org/10.1002/nau.23205
Perrouin-Verbe MA, Leon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phe V (2019) Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: a single-center experience in a multidisciplinary team. Neurourol Urodyn 38(1):330–337. https://doi.org/10.1002/nau.23857
Wu SY, Jiang YH, Kuo HC (2017) Long-term outcomes of augmentation enterocystoplasty in patients with end-stage bladder diseases: a single-institute experience involving 102 patients. Int Neurourol J 21(2):133–138. https://doi.org/10.5213/inj.1732708.354
Wu SY, Kuo HC (2018) A real-world experience with augmentation enterocystoplasty-high patient satisfaction with high complication rates. Neurourol Urodyn 37(2):744–750. https://doi.org/10.1002/nau.23339
Husmann DA (2018) Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: incidence and management of the non-lethal complications of bladder augmentation. Int J Urol 25(2):94–101. https://doi.org/10.1111/iju.13417
Veeratterapillay R, Thorpe AC, Harding C (2013) Augmentation cystoplasty: contemporary indications, techniques and complications. Indian J Urol 29(4):322–327. https://doi.org/10.4103/0970-1591.120114
Husmann DA (2016) Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration. Transl Androl Urol 5(1):3–11. https://doi.org/10.3978/j.issn.2223-4683.2015.12.06
Cox L, He C, Bevins J, Clemens JQ, Stoffel JT, Cameron AP (2017) Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization. Can Urol Assoc J 11(9):E350–E354. https://doi.org/10.5489/cuaj.4434
Szymanski KM, Misseri R, Whittam B, Lingeman JE, Amstutz S, Ring JD, Kaefer M, Rink RC, Cain MP (2016) Bladder stones after bladder augmentation are not what they seem. J Pediatr Urol 12(2):98. https://doi.org/10.1016/j.jpurol.2015.06.021(e91–96)
DeFoor W, Minevich E, Reddy P, Sekhon D, Polsky E, Wacksman J, Sheldon C (2004) Bladder calculi after augmentation cystoplasty: risk factors and prevention strategies. J Urol 172(5 Pt 1):1964–1966
Metcalfe PD, Cain MP, Kaefer M, Gilley DA, Meldrum KK, Misseri R, King SJ, Casale AJ, Rink RC (2006) What is the need for additional bladder surgery after bladder augmentation in childhood? J Urol 176(4 Pt 2):1801–1805. https://doi.org/10.1016/j.juro.2006.03.126(discussion 1805)
Welk B, Herschorn S, Law C, Nam R (2012) Population based assessment of enterocystoplasty complications in adults. J Urol 188(2):464–469. https://doi.org/10.1016/j.juro.2012.04.013
Hensle TW, Bingham J, Lam J, Shabsigh A (2004) Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol. BJU Int 93(4):585–587
Gonzalez RD, Whiting BM, Canales BK (2012) The history of kidney stone dissolution therapy: 50 years of optimism and frustration with renacidin. J Endourol 26(2):110–118. https://doi.org/10.1089/end.2011.0380
Brandell RA, Hall MC, Koch MO, Braren HV (1994) Exposure of intestinal segments to hemiacidrin: analysis of metabolic and histological effects using a rat model. J Urol 152(2 Pt 2):725–727. https://doi.org/10.1016/s0022-5347(17)32691-5(discussion 728–729)
Matlaga BR, Kim SC, Watkins SL, Kuo RL, Munch LC, Lingeman JE (2006) Changing composition of renal calculi in patients with neurogenic bladder. J Urol 175(5):1716–1719. https://doi.org/10.1016/S0022-5347(05)01015-3(discussion 1719)
Husmann DA (2017) Mortality following augmentation cystoplasty: a transitional urologist’s viewpoint. J Pediatr Urol 13(4):358–364. https://doi.org/10.1016/j.jpurol.2017.05.008
Husmann DA, Cain MP (2001) Fecal and urinary continence after ileal cecal cystoplasty for the neurogenic bladder. J Urol 165(3):922–925
N’Dow J, Leung HY, Marshall C, Neal DE (1998) Bowel dysfunction after bladder reconstruction. J Urol 159(5):1470–1474. https://doi.org/10.1097/00005392-199805000-00015(discussion 1474–1475)
Higuchi TT, Granberg CF, Fox JA, Husmann DA (2010) Augmentation cystoplasty and risk of neoplasia: fact, fiction and controversy. J Urol 184(6):2492–2496. https://doi.org/10.1016/j.juro.2010.08.038
Soergel TM, Cain MP, Misseri R, Gardner TA, Koch MO, Rink RC (2004) Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder. J Urol 172(4 Pt 2):1649–1651 (discussion 1651–1642)
Husmann DA, Rathbun SR (2008) Long-term follow up of enteric bladder augmentations: the risk for malignancy. J Pediatr Urol 4(5):381–385. https://doi.org/10.1016/j.jpurol.2008.06.003(discussion 386)
Mammadov E, Dervisoglu S, Elicevik M, Emir H, Soylet Y, Buyukunal SNC (2017) Transition to adulthood with a bladder augmentation: histopathologic concerns. Int Braz J Urol 43(6):1152–1159. https://doi.org/10.1590/S1677-5538.IBJU.2016.0548
Metcalfe PD, Casale AJ, Kaefer MA, Misseri R, Dussinger AM, Meldrum KK, Cain MP, Rink RC (2006) Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. J Urol 175(4):1466–1470. https://doi.org/10.1016/S0022-5347(05)00672-5(discussion 1470–1461)
Lee T, Kozminski DJ, Bloom DA, Wan J, Park JM (2017) Bladder perforation after augmentation cystoplasty: Determining the best management option. J Pediatr Urol 13(3):274. https://doi.org/10.1016/j.jpurol.2016.12.027(e271–274 e277)
Greenwell TJ, Venn SN, Creighton S, Leaver RB, Woodhouse CR (2003) Pregnancy after lower urinary tract reconstruction for congenital abnormalities. BJU Int 92(7):773–777
Telli O, Ozcan C, Hamidi N, Karagoz MA, Hascicek AM, Soygur T, Burgu B (2016) Preoperative risk factors predicting complication rates of augmentation cystoplasty using the modified clavien classification system in pediatric population. Urology 97:166–171. https://doi.org/10.1016/j.urology.2016.05.067
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Philip Cheng has no conflict of interest. Jeremy Myers is a consultant for Urotronic and an investor in StreamDx. He receives grant and research support from the Patient Centered Outcomes Research Institute (PCORI), the Department of Defense, the Nielsen Foundation, the American Urologic Association, and Boston Scientific.
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Cheng, P.J., Myers, J.B. Augmentation cystoplasty in the patient with neurogenic bladder. World J Urol 38, 3035–3046 (2020). https://doi.org/10.1007/s00345-019-02919-z
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DOI: https://doi.org/10.1007/s00345-019-02919-z