Long term results of augmentation cystoplasty and urinary diversion in multiple sclerosis

There is a paucity of data about augmentation cystoplasty (AC) in multiple sclerosis (MS) patients with refractory lower urinary tract symptoms (LUTS). The aim of this study is to evaluate the long term outcomes and morbidity of these procedures in MS patients.

This is a retrospective observational study of consecutive patients (1984-2017) with MS and refractory LUTS who underwent AC with or without a continent/incontinent abdominal stoma or urinary diversion. Pre and postoperative evaluations included routine labs, videourodynamic studies (VUDS), cystoscopy, and upper tract imaging. Long term outcomes and complications were assessed by validated questionnaires and/or chart review.

There were 17 patients (12 women, 5 men) ranging in age from 34-77 years. Thirteen patients were wheelchair-bound (10 quadriplegics, 3 paraplegics). Indications included neurogenic detrusor overactivity (NDO) in two, low bladder compliance (LBC) in 13 and both NDO and LBC in two. One patient committed suicide at 3 months, and one was lost to follow up. Of the remaining 15, median follow up was 13 years (range 4-22), and 11 were followed up until death. Overall, 14/15 (93%) had a successful outcome based on the Patient Global Impression of Improvement (PGI-I). With respect to incontinence, 14/15 (93%) had a successful outcome based on the Simplified Urinary Incontinence Score (SUIS). Median bladder capacity increased from 180 mL to 605 mL (p < 0.001). Median maximum detrusor pressure decreased from 63 cm H₂ O to 18 cm H₂O (p < 0.003). Two patients underwent stomal stenosis revisions, four patients had pyelonephritis, and two patients developed de novo bladder stones.

AC is a major surgical procedure with high potential morbidity, but these data suggest that AC is efficacious in the long term with acceptable morbidity and mortality. We believe it is an underutilized procedure for refractory LUTS in MS patients.