Alternative techniques for augmentation cystoplasty

We discuss conventional intestinal cystoplasty and show how concern about potential complications has led to an interest in alternative methods for cystoplasty. Techniques such as gastrocystoplasty, ureterocystoplasty, vesicomyomectomy (autoaugmentation), seromuscular augmentation, alloplastic replacement and bioprosthetic materials are reviewed. Laboratory and clinical results of these techniques are examined critically to compare advantages, disadvantages and potential applications.

Computer searches of available medical data bases were used to generate a list of relevant publications, including original contributions and review articles, which were then reviewed, compared and summarized.

Augmentation cystoplasty is used routinely for treatment of reduced bladder compliance and capacity secondary to infectious, inflammatory, neurogenic and congenital disorders. Sigmoidocystoplasty and ileocystoplasty have become standard techniques but there is renewed interest in alternative techniques due to the relatively high morbidity of intestinal cystoplasty. Alternative techniques have been described to avoid inclusion of intestinal mucosa in the urinary tract while creating a compliant bladder of adequate capacity. These techniques include gastrocystoplasty, vesicomyotomy, seromuscular augmentation, various alloplastic or biodegradable scaffolds and in vitro culture with subsequent grafting of autologous urothelium. Although encouraging animal and human results have been reported, each technique is associated with its own limitations and disadvantages.

While intestinal cystoplasty remains the standard, several alternative techniques show promise. At present only gastrocystoplasty, ureterocystoplasty and seromuscular augmentation should be considered clinically useful.