Ten years' experience with enterocystoplasty

Eighteen augmentation cystoplasties and 18 substitution cystoplasties were performed during the last 10 yrs. The indications for augmentation cystoplasty were tuberculous cystitis, interstitial cystitis, detrusor hyperreflexia, and a poor compliant neuropathic bladder. The indications for substitution cystoplasty were a neuropathic bladder and carcinoma of the bladder. Voiding was satisfactory in 11 cases of the augmentation cystoplasty group and in 14 cases of the substitution cystoplasty group. The remaining patients required clean intermittent self catheterization. Revision of the bladder neck was necessary after augmentation cystoplasty in 2 cases. Incontinence of urine occurred in 1 case of each group, both being neuropathic bladder cases with poor sphincter function. Incontinence from detrusor hyperreflexia present before the operation was improved after "clam" enterocystoplasty in all of the 3 cases. Enuresis occurred in 11 cases of the substitution cystoplasty group. Early complications included troublesome mucus plugs, perforation of the neobladder, a persistent suprapubic fistula and one perioperative death. A total of 23 patients were available for follow-up for an average of 17 months (range 6 months to 8 yrs). Thirteen were alive and well, 5 were alive with poor health. Late complications included uretero-vesical junction obstruction, vesico-ureteric reflux, vesical stones, recurrent urinary tract infection, entero-vesical junction narrowing, renal deterioration, gut obstruction, death from chronic renal failure, and death from progression of carcinoma of the bladder. The reoperation rate for complications was 7/23 or 30.43 per cent. The entero-cystoplasty is an operation not to be taken lightly because of the complications and reoperation rate.