Bowel problems after enterocystoplasty

To document the changes in bowel habit in patients who have undergone enterocystoplasty.

Sixty-nine patients with neuropathic (NP) and 44 with non-neuropathic (NNP) bladder dysfunction (mean age 26 years, range 13-61, 93.6% socially continent), followed for at least 36 months after cystoplasty, were assessed using a questionnaire addressing faecal frequency, consistency, method of evacuation and incontinence episodes before and after surgery.

Of the patients with NP bladder dysfunction, 26 (38%) had more and seven (10%) less frequent bowel action after surgery, with 36 (52%) unchanged; 38 (55%) of patients had unchanged consistency, 26 (38%) were looser and five (7%) more constipated; 41 (59%) opened their bowels as before, 16 (23%) needed more help and 12 (17%) less help to evacuate; 16 (23%) patients had more and 17 (25%) less episodes of incontinence; 21 (30%) patients felt their bowels had not become normal after their operation and only 24 (35%) that they had returned to normal within 3 months of their operation. The bowel segment used was ileum in 44 patients, ileocaecal in 11 and sigmoid cystoplasty in 14. Patients with intact ileum did not have the same degree of diarrhoea, with only three of the 14 patients with a sigmoid cystoplasty being adversely affected. Of the patients with NNP bladder dysfunction, 18 patients (41%) had a more and five (11%) a less frequent bowel action; 20 (46%) had more loose and five (11%) less loose bowel action; similar numbers (five and four) needed either an increase or a decrease in laxatives or enemata: surprisingly, 12 patients (27%) felt they had an increase in the episodes of incontinence; 17 (39%) patients felt their bowels returned to normal within 3 months of surgery and 30% felt their bowels had not become normal after surgery. Only one patient in this group had a sigmoid cystoplasty and she did not find that the operation interfered with her bowel function.

Ileal resection results in malabsorption of bile acids, maldigestion of fat and an imbalance of water and electrolytes. Patients with neurogenic bladders are finely balanced between acceptable bowel function and choas, and surgery often tips this balance the wrong way. In 30% of the present patients, bowel problems persisted after surgery, with 38% having increased frequency. 38% having looser consistency and 23% more incontinence episodes following surgery. More surprisingly, a high percentage of NNP patients had bowel problems after cystoplasty.