Reconstructive surgery in voiding dysfunction: experience with 69 patients

To present our reconstructive surgery experience with voiding dysfunction due to both neurologic and non-neurologic etiology.

From March 1993 to January 2000, 69 patients (43 men and 26 women) with voiding dysfunction underwent lower urinary tract reconstruction. Mean patient age at the time of surgery was 34. 5 years (range 9 to 75). Voiding dysfunction had a neurologic etiology in 65.2% of the patients and a non-neurologic etiology in 34.8%. Urodynamic investigation revealed poor bladder compliance in 52%, detrusor hyperreflexia in 19%, and a combination of the two in 29% of the patients. Thirteen patients (19%) had coexistent intrinsic sphincteric deficiency. A total of 56.5% of the patients had upper urinary tract deterioration. Most patients (78%) had severe urinary incontinence. Augmentation cystoplasty was performed in 60 patients. Nine patients had augmentation cystoplasty with a continent stoma. Concomitant procedures were performed in 11 patients.

Mean follow-up was 36.6 months (range 8 to 108). Marked improvement of the upper tracts was documented in 79% of the patients in the neuropathic and 73% in the non-neuropathic group. High continence rates were achieved in both groups (82% and 94%, respectively). Intermittent catheterization rate was 88.6% in the neuropathic and 44% in the non-neuropathic groups and patient satisfaction rate was 84% and 94%, respectively. Three major complications in 2 patients required surgery.

Surgical reconstruction to treat urinary incontinence and upper urinary tract deterioration gives satisfactory results in voiding dysfunction in the case of medical treatment failure.