Symptomatic outcome following clam ileocystoplasty

This study was designed to assess the outcome of clam ileocystoplasty (CI) based on patients' subjective perception and objectively validated scoring systems. Quality-of-life parameters were also examined as aspects of outcome.

Between 1989 and 1994, 27 patients (15 male and 12 female) underwent CI. The median age was 41 years (13-75 years). CI was performed after failed pharmacological treatment. The mean length of follow-up for this patient cohort was 18 months (range: 1-4 years).

Overall cure rate was objectively assessed at 61%. Seventy-two percent of patients described a subjective improvement of symptoms, and a small number of patients (12.5%) were subjectively worse following the operation. Quality of life was improved in 75% of patients, with 12.5% showing no improvement and 12.5% being worse. Fifty-six percent of patients noted a minor degree of voiding dysfunction, whereas 25% noted moderate and 19% noted severe voiding dysfunction.

CI offered improvement with satisfaction in the group of patients studied, however not all patients achieved a satisfactory outcome. The patients who were worse following the procedure were all young females with detrusor instability. Careful patient selection and pre-operative counselling may reduce the failure rate. Outcome analysis based on standardised questionnaires allows patients and surgeons to make informed decisions with realistic expectations.