Abstract
Objectives
Augmentation enterocystoplasty is the standard treatment for patients with neurogenic bladder who have failed medical management. Our “extraperitoneal” approach involves a small peritoneotomy to obtain the segment of bowel for augmentation, and a standard “clam” enterocystoplasty. We compared operative and postoperative parameters and clinical outcomes of this technique with the standard intraperitoneal technique.
Methods
We retrospectively reviewed charts of 73 patients with neurogenic voiding dysfunction refractory to medical management who underwent augmentation enterocystoplasty alone or in conjunction with additional procedures. A total of 49 patients underwent extraperitoneal augmentation and 24 patients underwent intraperitoneal augmentation. Operative and postoperative parameters including time of surgery, estimated blood loss, need for blood transfusion, time for return of bowel function, and length of hospital stay were examined. Clinical outcomes including early and late postoperative complications, and continence status were also analyzed.
Results
Median follow-up was 2.5 years. Patients in the extraperitoneal group had significantly shorter operative time (3.9 vs. 5.6 h, P < 0.0001); shorter hospital stay (8.0 vs. 10.5 days, P = 0.009); and shorter time to return of bowel function (3.5 vs. 4.9 days, P = 0.0005). There was no significant difference in complication rates. Postoperative continence was equally improved in both groups. When only patients with no prior abdominal surgery were compared, the findings were analogous: shorter operative time, shorter length of stay, sooner return of bowel function, and no difference in complication rate.
Conclusions
The extraperitoneal technique provides an equally effective method of bladder augmentation to the standard technique with easier early postoperative recovery.
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References
George VK, Russell GL, Shutt A, Gaches CG, Ashken MH (1991) Clam ileocystoplasty. Br J Urol 68:487–489
Greenwell TJ, Venn SN, Mundy AR (2001) Augmentation cystoplasty. BJU Int 88:511–525
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 43:263–269. doi:10.1016/S0302-2838(03)00008-3
Albo ME, Raz S, Dupont MC (1997) Anterior flap extraperitoneal cystoplasty. J Urol 157:2095–2098. doi:10.1016/S0022-5347(01)64683-4
Bramble FJ (1982) The treatment of adult enuresis and urge incontinence by enterocystoplasty. Br J Urol 54:693–696
Venn SN, Mundy AR (1998) Long-term results of augmentation cystoplasty. Eur Urol 34:40–42. doi:10.1159/000052275
Quek ML, Ginsberg DA (2003) Long-term urodynamics followup of bladder augmentation for neurogenic bladder. J Urol 1(69):195–198
Hendren WH, Hendren RB (1990) Bladder augmentation: experience with 129 children and young adults. J Urol 144:445–453
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 176:1801–1805. doi:10.1016/j.juro.2006.03.126
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Reyblat, P., Chan, K.G., Josephson, D.Y. et al. Comparison of extraperitoneal and intraperitoneal augmentation enterocystoplasty for neurogenic bladder in spinal cord injury patients. World J Urol 27, 63–68 (2009). https://doi.org/10.1007/s00345-008-0351-3
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DOI: https://doi.org/10.1007/s00345-008-0351-3