Long-term outcomes of augmentation enterocystoplasty with an ileal segment in patients with spinal cord injury

Abstract

Background/purpose: Neurogenic bladder has been considered a relative contraindication for augmentation enterocystoplasty (AE), but neurogenic voiding dysfunction has become a common indication for AE. We evaluated long-term outcomes in patients with spinal cord injury (SCI) who underwent AE with an ileal segment.

Methods: We reviewed retrospectively 40 consecutive adults with SCI who underwent AE. The outcomes assessed included bladder capacity and compliance, incidence of stone formation, upper urinary tract status, urinary tract infection (UTI), need for intermittent catheterization, urinary incontinence, postoperative morbidity, persistent loose stools, and metabolic malabsorption.

Results: Four women and 36 men aged 20-56 years (mean, 36.3 +/- 8.8 years), with a mean follow-up period of 7.8 +/- 0.6 years were included. Twenty-nine (72.5%) patients had detrusor overactivity and the other 11 had detrusor underactivity. Simple AE was performed in 27 patients, AE with ureteral reimplantation in seven, and continent diversion by enterocystoplasty with an abdominal stoma in six. The mean bladder capacity increased from 115 +/- 16.3 to 513 +/- 31.4 mL after the operation. Four patients (10%) could void spontaneously and 29 (72.5%) had to perform clean intermittent catheterization to empty their bladders. Twenty-six patients (65%) had episodes of UTI. Three patients (7.5%) experienced de novo diarrhea that required antispasmodics. Long-term complications included urinary incontinence in four (10%) patients, reservoir calculi in 13 (32.5%) and new-onset upper tract stones in nine (22.5%).

Conclusion: AE with an ileal segment provides effective and safe therapeutic outcomes in SCI patients. However, problems with UTI, reservoir calculi and new-onset upper tract urolithiasis still need to be solved.