[Augmentation cystoplasty and intermittent catheterization in neurogenic bladder]

Area of Science:

• Urology
• Neurosurgery
• Reconstructive Surgery

Background:

• Paraplegic patients often suffer from hyperreflexic neurogenic bladder secondary to supra-sacral medullary injuries.
• This condition leads to significant morbidity, including incontinence, recurrent urinary tract infections, vesicoureteral reflux, and autonomic dysreflexia.

Purpose of the Study:

• To evaluate the efficacy of enterocystoplasty in managing hyperreflexic neurogenic bladder in adult paraplegic patients.
• To assess the impact of the procedure on urinary continence, upper urinary tract status, and autonomic dysreflexia.

Main Methods:

• Enterocystoplasty using detubularized ileum (16 cases) or sigmoid (1 case) was performed on 17 paraplegic adult patients.
• Adjunctive procedures included ureteral reimplantation (1), artificial urinary sphincter implantation (1), and periurethral Teflon paste injection (1).
• Follow-up duration was 16 months.

Main Results:

• All 17 patients achieved continence with self-intermittent catheterization post-surgery.
• The upper urinary tract remained stable or showed improvement in all patients.
• No instances of autonomic dysreflexia were reported after the procedure.
• Thirteen patients had asymptomatic bacteriuria, managed conservatively.

Conclusions:

• Enterocystoplasty is a safe and effective treatment for hyperreflexic neurogenic bladder in paraplegic adults.
• The procedure significantly improves urinary continence and preserves upper urinary tract function.
• Enterocystoplasty can mitigate complications like autonomic dysreflexia in this patient population.