Augmentation cystoplasty in the treatment of neurogenic bladder dysfunction

We report on the role of augmentation cystoplasty in the treatment of 18 patients with neurogenic bladder dysfunction and associated symptoms of severe urinary urgency, frequency and urinary incontinence. All patients failed to obtain any symptomatic improvement with a variety of treatments, including intermittent self-catheterization and pharmacologic manipulation. Preoperative evaluation helped segregate the patients into 3 groups: 1) those with extremely poor bladder wall compliance, 2) those with severe detrusor hyperreflexia and 3) those with a combined problem of poor bladder wall compliance and hyperreflexia. Bladder augmentation involved cecocystoplasty in 15 cases and ileocystoplasty in 3. In 5 patients an artificial urinary sphincter cuff was placed in an attempt to improve continence. Followup ranging from 12 to 120 months (mean 38 months) was available in 17 patients. An excellent surgical result was obtained in 82 per cent of the patients who became asymptomatic and continent after augmentation cystoplasty. Augmentation cystoplasty is a therapeutic modality that should be considered a viable treatment option in selected patients with neurogenic bladder dysfunction.