Skip to main content

Advertisement

Log in

Bladder Augmentation (Enterocystoplasty): the Current State of a Historic Operation

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this paper was to evaluate the current use of enterocystoplasty, a historical operation for bladder dysfunction but with continued and increasing modern relevance.

Recent Findings

Since the advent of third line neuromodulation techniques for neurogenic and idiopathic overactive bladder (OAB), the usage of enterocystoplasty has decreased. However, this procedure continues to be utilized in pediatric urology patients and the most refractory OAB patients. Adult urologist should be familiar with this operative technique in an effort to manage pediatric patients transitioning to adulthood. Minimally invasive techniques for this surgical procedure have been described with very limited outcome data.

Summary

It is important for all urologists to be familiar with enterocystoplasty, both technically and with the unique needs of these patients postoperatively. Further studies evaluating the outcomes of this procedure in idiopathic overactive bladder patients and efforts to standardize recommendations for neurogenic bladder patients will help guide care in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Von Mikulicz J. Zur. Operation der Angebarenen Blasenspalte. Zentralbl Chir. 1889;20:641–3.

    Google Scholar 

  2. Couvelaire R. La petite vessie des tuberculeux genito-urinaires: essai de classification, places et variantes des cysto-intestinoplasties. J Urol (Paris). 1950;56:381–434.

    CAS  Google Scholar 

  3. Neuhof H. Fascia transplantation into a visceral defect. Surg Gynecol Obstet. 1917;24:383–4.

    Google Scholar 

  4. Elbahnasy AM, Shalhav A, Hoenig DM, Figenshau R, Clayman RV. Bladder wall substitution with synthetic and non-intestinal organic materials. J Urol. 1998;159:628–37.

    Article  CAS  Google Scholar 

  5. Barrett DM, Donovan MG. Prosthetic bladder augmentation and replacement. Semin Urol. 1984;2:167–75.

    CAS  PubMed  Google Scholar 

  6. Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int. 2012;109:1280–93. https://doi.org/10.1111/j.1464-410X.2011.10650.x.

    Article  PubMed  Google Scholar 

  7. Krieger JN, Stubenbord WT, Vaughan ED Jr. Transplantation in children with end stage renal disease of urologic origin. J Urol. 1980;124:508–12.

    Article  CAS  Google Scholar 

  8. Thomalla JV, Mitchell ME, Leapman SB, Filo RS. Renal transplantation into the reconstructed bladder. J Urol. 1989;141:265–8.

    Article  CAS  Google Scholar 

  9. Basiri A, Hosseini Moghaddam S, Khoddam R. Augmentation cystoplasty before and after renal transplantation: long-term results. Transplant Proc. 2002;34:2106–8.

    Article  CAS  Google Scholar 

  10. Nahas WC, Mazzucchi E, Arap MA, Antonopoulos IM, et al. Augmentation cystoplasty in renal transplantation: a good and safe option—experience with 25 cases. Urology. 2002;60:770–4.

    Article  Google Scholar 

  11. Capizzi A, Zanon GF, Zacchello G, Rigamonti W. Kidney transplantation in children with reconstructed bladder. Transplantation. 2004;77:1113–6.

    Article  CAS  Google Scholar 

  12. Cetinel B. Reconstructive surgery in neuropathic bladder. Adv Exp Med Biol. 2003;539:509–33.

    PubMed  Google Scholar 

  13. Çetinel B, Kocjancic E, Demirdağ Ç. Augmentation cystoplasty in neurogenic bladder. Investig Clin Urol. 2016;57:316–23. https://doi.org/10.4111/icu.2016.57.5.316.

    Article  PubMed  PubMed Central  Google Scholar 

  14. •• Cheng KC, Kan CF, Chu P, et al. Augmentation cystoplasty: urodynamic and metabolic outcomes at 10-year follow-up. Int J Urol. 2015;22:1149–54. https://doi.org/10.1111/iju.12943 T hough only 40 patients are included in this study, it gives a good summary of urodynamic changes that can be expected after augmentation cystoplasty.

    Article  PubMed  Google Scholar 

  15. Kuss R, Bitker M, Camey M, Chatelain C, Lassau JP. Indications and early and late results of intestino-cystoplasty: a review of 185 cases. J Urol. 1970;103:53–63.

    Article  CAS  Google Scholar 

  16. Smith RB, Cangh P, Skinner DG, Kaufman JJ, Goodwin WE. Augmentation enterocystoplasty: a critical review. J Urol. 1977;118:35–9.

    Article  CAS  Google Scholar 

  17. Hendren WH, Hendren RB. Bladder augmentation: experience with 129 children and young adults. J Urol. 1990;144:445–53.

    Article  CAS  Google Scholar 

  18. Murray K, Nurse DE, Mundy AR. Secreto-motor function of intestinal segments used in lower urinary tract reconstruction. Br J Urol. 1987;60:532–5.

    Article  CAS  Google Scholar 

  19. Whitmore WF, Gittes RF. Reconstruction of the urinary tract by cecal and ileocecal cystoplasty: review of a 15-year experience. J Urol. 1983;129:494–8.

    Article  Google Scholar 

  20. Fromm D. Ileal resection or disease and the blind loop syndrome: current concepts and pathophysiology. Surgery. 1973;73:639–48.

    CAS  PubMed  Google Scholar 

  21. Leonard MP, Dharamsi N, Williot PE. Outcome of gastrocystoplasty in tertiary pediatric urology practice. J Urol. 2000;164:947–50.

    Article  CAS  Google Scholar 

  22. Plawker MW, Rabinowitz SS, Etwark DJ, et al. Hypergastrinemia, dysuria-hematuria and metabolic alkalosis: complications associated with gastrocystoplasty. J Urol. 1995;154:546–9.

    Article  CAS  Google Scholar 

  23. Reinberg Y, Manivel JC, Froemming C, Gonzolez R. Perforation of the gastric segment of an augmented bladder secondary to peptic ulcer disease. J Urol. 1992;148:369–71.

    Article  CAS  Google Scholar 

  24. Bogaert GA, Mevorach RA, Kogan BA. Urodynamic and clinical follow-up of 28 children after gastrocystoplasty. Br J Urol. 1994;74:469–75.

    Article  CAS  Google Scholar 

  25. Vemulakonda VM, Lendvay TS, Shnorhavorian M, et al. Metastatic adenocarcinoma after augmentation gastrocystoplasty. J Urol. 2008;179:1094–6. https://doi.org/10.1016/j.juro.2007.10.089.

    Article  Google Scholar 

  26. Balachandra B, Swanson PE, Upton MP, Yeh MM. Adenocarcinoma arising in a gastrocystoplasty. J Clin Pathol. 2007;60:85–7. https://doi.org/10.1136/jcp.2005.035196.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Baydar DE, Allan RW, Castellan M, Labbie A, Epstein JI. Anaplastic signet ring cell carcinoma arising in gastrocystoplasty. Urology. 2005;65:1226. https://doi.org/10.1016/j.urology.2004.12.027.

    Article  PubMed  Google Scholar 

  28. Esquena Fernandez S, Abascal JM, Tremps E, Morote J. Gastric cancer in augmentation gastrocystoplasty. Urol Int. 2005;74:368–70. https://doi.org/10.1159/000084441.

    Article  PubMed  Google Scholar 

  29. Castellan M, Gosalbez R, Perez-Brayfield M, et al. Tumor in bladder reservoir after gastrocystoplasty. J Urol. 2007;178:1771–4. https://doi.org/10.1016/j.juro.2007.05.100.

    Article  Google Scholar 

  30. Vajda P, Kaisern L, Magyarlaki T, Farkas A, Vastyan AM, Pinter AB. Histological findings after colocystoplasty and gastrocystoplasty. J Urol. 2002;168:698–701.

    Article  CAS  Google Scholar 

  31. Qiu H, Kordunskaya S, Yantiss RK. Transitional cell carcinoma arising in the gastric remnant following gastrocystoplasty: a case report and review of the literature. Int J Surg Pathol. 2003;11:143–7. https://doi.org/10.1177/106689690301100216.

    Article  PubMed  Google Scholar 

  32. •• Biardeau X, Chartier-Kastler E, Rouprêt M, Phé V. Risk of malignancy after augmentation cystoplasty: a systematic review. Neurourol Urodyn. 2016;35:675–82. https://doi.org/10.1002/nau.22775 57 articles were reviewed providing a thorough summary of evidence available for the risk of malignancy after bladder augmentation.

    Article  PubMed  Google Scholar 

  33. Docimo SG, Moore RG, Adams J, Kavoussi LR. Laparoscopic bladder augmentation using stomach. Urology. 1995;46:565–9.

    Article  CAS  Google Scholar 

  34. Gill IS, Rackley RR, Meraney AM, Marcello PW, Sung GT. Laparoscopic enterocystoplasty. Urology. 2000;55:178–81.

    Article  CAS  Google Scholar 

  35. •• Cohen AJ, Brodie K, Murthy P, Wilcox DT, Gundeti MS. Comparative Outcomes and Perioperative Complications of Robotic Vs Open Cystoplasty and Complex Reconstructions. Urology. 2016;97:172–8. https://doi.org/10.1016/j.urology.2016.06.053 This paper is important because there is continued interest in feasibility in performing this procedure with minimally invasive techniques. Although, their findings showed equivalent rates of complications, length of stay and blood loss.

    Article  PubMed  Google Scholar 

  36. Smith P, Hardy GJ. Carcinoma occurring as a late complication of ileocystoplasty. Br J Urol1971: 43: 576–579

    Article  CAS  Google Scholar 

  37. Higuchi TT, Granberg CF, Fox JA, et al. Augmentation cystoplasty and risk of neoplasia: Fact, fiction and controversy. J Urol. 2010;184:2492–6. https://doi.org/10.1016/j.juro.2010.08.038.

    Article  CAS  PubMed  Google Scholar 

  38. Austen JC, Elliott S, Cooper CS. Patients with spina bifida and bladder cancer: atypical presentation, advanced stage and poor survival. J Urol. 2007;178:798–801. https://doi.org/10.1016/j.juro.2007.05.055.

    Article  Google Scholar 

  39. Soergel TM, Cain MP, Misseri R, et al. Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder. J Urol. 2004;172:1649–51.

    Article  Google Scholar 

  40. Filmer RB, Spencer JR. Malignancies in bladder augmentations and intestinal conduits. J Urol. 1990;143:671–7.

    Article  CAS  Google Scholar 

  41. Zabbo A, Kay R. Ureterosigmoidoscopy and bladder exstrophy: a long-term follow-up. J Urol. 1986;136:396–8.

    Article  CAS  Google Scholar 

  42. Kälble T, Tricker AR, Möhring K, Berger MR, Geiss H, Staehler G. The role of nitrate, nitrite and N-nitrosamines in the carcinogenesis of colon tumours following ureterosigmoidostomy. Urol Res. 1990;18:123–9.

    Article  Google Scholar 

  43. Ali-El-Dein B, El-Tabey N, Abdel-Latif M, et al. Late uro-ileal cancer after incorporation of ileum into the urinary tract. J Urol. 2002;167:84–8.

    Article  Google Scholar 

  44. Husmann DA, Rathbun SR. Long-term follow up of enteric bladder augmentations: The risk for malignancy. J Pediatr Urol. 2008;4:381–5. https://doi.org/10.1016/j.jpurol.2008.06.003.

    Article  CAS  PubMed  Google Scholar 

  45. Kalble T, Hofmann I, Riedmiller H, et al. Tumor growth in urinary diversion: A multicenter analysis. Eur Urol. 2011;60:1081–6. https://doi.org/10.1016/j.eururo.2011.07.006.

    Article  PubMed  Google Scholar 

  46. Kispal Z, Balogh D, Erdei O, et al. Complications after bladder augmentation or substitution in children: A prospective study of 86 patients. BJU Int. 2011;108:282–9. https://doi.org/10.1111/j.1464-410X.2010.09862.x.

    Article  PubMed  Google Scholar 

  47. Roth JD, Koch MO. Metabolic and nutritional consequences of urinary diversion using intestinal segments to reconstruct the urinary tract. Urol Clin North Am. 2018;45:19–24. https://doi.org/10.1016/j.ucl.2017.09.007.

    Article  PubMed  Google Scholar 

  48. Greenwell TJ, Venn SN, Mundy AR. Augmentation cystoplasty. BJU Int. 2001;88:511–25.

    Article  CAS  Google Scholar 

  49. Khoury AE, Salomon M, Doche R, et al. Stone formation after augmentation cystoplasty: the role of intestinal mucus. J Urol. 1997;158:1133–7.

    Article  CAS  Google Scholar 

  50. Robertson W, Woodhouse C. Metabolic factors in the causation of urinary tract stones in patients with enterocystoplasties. Urol Res. 2006;34:231–8.

    Article  CAS  Google Scholar 

  51. Kaefer M, Hendren WH, Bauer SB, et al. Reservoir calculi: a comparison of reservoirs constructed from stomach and other enteric segments. J Urol. 1998;160:2187–90.

    Article  CAS  Google Scholar 

  52. Kronner KM, Casale AJ, Cain MP, et al. Bladder calculi in the pediatric augmented bladder. J Urol. 1998;160:1096–8.

    Article  CAS  Google Scholar 

  53. Roberts WW, Gearhart JP, Mathews RI. Time to recurrent stone formation in patients with bladder or continent reservoir reconstruction: fragmentation versus intact stone extraction. J Urol. 2004;172:1706–8.

    Article  Google Scholar 

  54. Scales CD Jr, Wiener JS. Evaluating outcomes of enterocystoplasty in patients with spina bifida: a review of the literature. J Urol. 2008;180:2323–9. https://doi.org/10.1016/j.juro.2008.08.050.

    Article  PubMed  Google Scholar 

  55. Clayman RV. Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol. J Urol. 2005;173:866–7.

    PubMed  Google Scholar 

  56. Barroso U, Jednak R, Fleming P, et al. Bladder calculi in children who perform clean intermittent catheterization. BJU Int. 2000;85:879–84.

    Article  CAS  Google Scholar 

  57. DeFoor W, Minevich E, Reddy P, et al. Bladder calculi after augmentation cystoplasty: risk factors and prevention strategies. J Urol. 2004;172(5 Pt 1):1964–6.

    Article  Google Scholar 

  58. Schlomer BJ, Saperston K, Copp H. Cumulative incidence of complications and urologic procedures afteraugmentation cystoplasty in children. J Urol. 2013;189:e200. https://doi.org/10.1016/j.juro.2013.02.1879

  59. Hensle TW, Bingham J, Lam BJ, Shabsigh A. Preventing reservoir calculi after augmentation cystoplasty and continence urinary diversion: the influence of an irrigation protocol. BJU Int. 2004;93:585–7.

    Article  CAS  Google Scholar 

  60. Szymanski KM, Misseri R, Whittam B, et al. Cutting for stone in augmented bladders–what is the risk of recurrence and is it impacted by treatment modality? J Urol. 2014;191:1375–80. https://doi.org/10.1016/j.juro.2013.11.057.

    Article  PubMed  Google Scholar 

  61. Roth JD, Cain MP. Neuropathic Bladder and Augmentation Cystoplasty. Urol Clin North Am. 2018;45:571–85. https://doi.org/10.1016/j.ucl.2018.06.005.

    Article  PubMed  Google Scholar 

  62. Husmann DA. 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. 2016;5:3–11. https://doi.org/10.3978/j.issn.2223-4683.2015.12.06.

    Article  PubMed  PubMed Central  Google Scholar 

  63. • Szymanski KM, Misseri R, Whittam B, Lingeman JE, Amstutz S, Ring JD, et al. Bladder stones after bladder augmentation are not what they seem. J Pediatr Urol. 2016;12:98 e1–6. https://doi.org/10.1016/j.jpurol.2015.06.021 A retrospective review of 107 patients who had undergone bladder augmentation, summarizing the risks of both upper tract and lower tract urinary calculi. They found a significant proportion are not actually infectious stones.

    Article  Google Scholar 

  64. Drake MJ, Apostolidis A, Emmanuel A, Gajewski J, Harrison SC, Heesakkers J, et al. Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 5th ed. Paris: ICUD-EAU; 2013.

    Google Scholar 

  65. Metcalfe PD, Casale AJ, Kaefer MA, Misseri R, Dussinger AM, Meldrum KK, et al. Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. J Urol. 2006;175:1466–70. https://doi.org/10.1016/S0022-5347(05)00672-5.

    Article  CAS  PubMed  Google Scholar 

  66. Hubert KC, Large T, Leiser J, et al. Long-Term Renal Functional Outcomes after Primary Gastrocystoplasty. J Urol. 2015;193:2079–84. https://doi.org/10.1016/j.juro.2014.12.088.

    Article  PubMed  Google Scholar 

  67. • Wu SY, Jiang YH, Kuo HC. Long-term Outcomes of Augmentation Enterocystoplas-ty in Patients With End-Stage Bladder Diseases: A Single-Institute Experience Involving 102 Patients. Int Neurourol J. 2017;21:133–8. https://doi.org/10.5213/inj.1732708.354 102 patients, primarily with neurogenic bladder, were followed for a mean of 78 months after bladder augmentation. They reported 52.9% with moderate to excellent satisfaction and CIC being a common cause for dissatisfaction.

    Article  PubMed  PubMed Central  Google Scholar 

  68. •• Wu SY, Kuo HC. A real-world experience with augmentation enterocystoplasty-High patient satisfaction with high complication rates. Neurourol Urodyn. 2018;37:744–50. https://doi.org/10.1002/nau.23339 79 patients were followed for a mean of 128 months after augmentation. They reported rates of catheterization and that renal function did not significantly change after the procedure. They reported 86.8% with moderate to excellent satisfaction.

    Article  PubMed  Google Scholar 

  69. • Perrouin-Verbe MA, Léon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phé V. Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: A single-center experience in a multidisciplinary team. Neurourol Urodyn. 2019;38:330–7. https://doi.org/10.1002/nau.23857 Their population was followed for a median of 13.6 years. Only one case of bladder cancer was observed after 26 years. They found a continence rate of 71% and 14% requiring reoperation.

    Article  PubMed  Google Scholar 

  70. •• Hoen L, Ecclestone H, BFM B, Karsenty G, Phé V, Bossier R, et al. Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review. Neurourol Urodyn. 2017;36:1685–702. https://doi.org/10.1002/nau.23205 20 studies and 511 patients were reviewed showing improved quality of life and stable renal function. They reported a long-term complication rate to be around 15%.

    Article  Google Scholar 

  71. • Mehmood S, Alhazmi H, Al-Shayie M, Althobity A, Alshammari A, Altaweel WM, et al. Long-term outcomes of augmentation cystoplasty in a pediatric population with refractory bladder dysfunction: A 12-Year follow-up experience at single center. IntNeurourol J. 2018;22:287–94. https://doi.org/10.5213/inj.1836174.087 42 patients were followed for a median of 12 years. Renal function, continence and reoperation was reported. They identified no cases of bladder perforation or malignancy.

    Article  Google Scholar 

  72. Lima DX, Pires CR, Santos AC, Mendes RG, Fonseca CE, Zocratto OB. Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder. Int Braz J Urol. 2015;41:542–6. https://doi.org/10.1002/nau.23849.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. •• Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, et al. 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. 2019;38:285–94. https://doi.org/10.1002/nau.23849 Neurogenic Bladder Research Group is an important multicenter collaborative evaluating various neurogenic bladder research questions. In this paper they evaluated spinal cord injury patients who were either performing CIC alone, CIC with botulinum toxin or CIC after bladder augmentation. 879 patients were included and CIC after augmentation had improved quality of life scores compared to the other groups.

    Article  CAS  PubMed  Google Scholar 

  74. Hensle TW, Bringham JB, Reiley EA, Cleary-Goldman JE, Malone FD, Robinson JN. The Urological Care and Outcome of Pregnancy After Urinary Tract Reconstruction. BJU Int. 2004;93:588–90. https://doi.org/10.111/j.1464-410X.2003.04665.x.11111

  75. Kapoor D, Chipde S, Agrawal S, Chipde S, Kapoor R. Delivery after augmentation cystoplasty: Implications and precautions. J Nat Sc Biol Med. 2014;5:206. https://doi.org/10.4103/0976-9668.127334.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Humphrey Atiemo.

Ethics declarations

Conflict of Interest

Jeffrey Budzyn, Hamilton Trinh, Samantha Raffee, and Humphrey Atiemo each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Budzyn, J., Trinh, H., Raffee, S. et al. Bladder Augmentation (Enterocystoplasty): the Current State of a Historic Operation. Curr Urol Rep 20, 50 (2019). https://doi.org/10.1007/s11934-019-0919-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-019-0919-z

Keywords

Navigation