Augmenting the augmented bladder: treatment of the contractile bowel segment

Area of Science:

• Urology
• Surgical Innovation
• Patient Outcomes

Background:

• Enterocystoplasty, a common bladder reconstruction technique, can result in residual bowel contractile properties.
• Some patients develop high-pressure bladder contractions post-augmentation, necessitating further intervention.

Purpose of the Study:

• To evaluate the effectiveness of re-augmentation in patients experiencing persistent high-pressure bladder contractions after primary enterocystoplasty.
• To analyze the reasons for repeat augmentation and the outcomes of additional bowel segment placement.

Main Methods:

• Retrospective review of 19 patients requiring repeat bladder augmentation.
• Evaluation of reasons for re-augmentation, upper tract changes, original and secondary bowel segments, and urodynamic findings.
• Assessment of current status and follow-up duration post-re-augmentation.

Main Results:

• Post-initial augmentation complications included incontinence, bladder perforation, upper tract changes, and pain.
• Preoperative urodynamics showed detrusor pressures ranging from 30 to 100 cm H2O.
• Re-augmentation, primarily with ileum, resolved incontinence in 10 of 11 patients and all upper tract changes, with a mean follow-up of 52 months.

Conclusions:

• Re-evaluating bladder dynamics is crucial when enterocystoplasty outcomes are suboptimal.
• Re-augmentation with an additional bowel segment is an effective solution for high-pressure bladder contractions and functionally small bladder capacity.
• This approach significantly decreases contractions and increases functional bladder capacity, leading to favorable clinical outcomes.