Nonsecretory intestinocystoplasty: a 15-year prospective study of 183 patients

Abstract

Purpose: Children and young adults treated with augmentation procedures with total intestinal flaps are at increased risk for specific complications in the long term. The aim of the present study was to demonstrate the long-term results of demucosalized bladder augmentation.

Materials and methods: A total of 183 patients (92 males and 91 females) were treated with bladder augmentation with the use of de-epithelialized intestinal segments. Patient age ranged from 3 months to 53 years, with a mean of 13.51 years (median 11.0). Of the patients 121 (66.1%) presented with neurogenic bladder, 50 (27.3%) with bladder exstrophy, 7 (3.8%) with tuberculosis, 4 (2.2%) with posterior urethral valves and 1 (0.5%) with female hypospadias. A mold over which the de-epithelialized segment of bowel was applied was used in all patients. A total of 151 cases were augmented using sigmoid colon and 32 using ileum. Data from bladder capacity and compliance were used to evaluate the results.

Results: Mean followup was 75.6 months (range 2 to 189). A total of 23 cases (12.6%) were considered failures. Mean bladder capacity was 250.0 ml. An increase of 342.4% was observed postoperatively. Median preoperative compliance was 1.6 ml/cm/H2O. An increase of 762.5% was observed during followup. Seven patients presented with bladder stones. Spontaneous bladder perforation was seen in 2 cases.

Conclusions: Significant increase in bladder capacity and compliance was achieved and maintained in the long term. The number of complications was lower compared to traditional methods of augmentation.