Surgical Augmentation of the Bladder to Enhance Volume

Author Year
Country
Research Design
Score
Total Sample Size

Methods Outcome
Gobeaux et al. 2012
France
Pre-Post
N=61
Population: Mean age: 34.7±11.2 yr (range=14-68); Gender: males=30, females=31; Level of injury: Above T6=18, T6-12=32, Below T12=11; Injury etiology: Traffic accident=41, Defenestration=7, Spinal cord surgery=6, Sport=3, Firearm=3, Other=1.Mean time post-injury: 9.7±1.6 yr.

Treatment: Patients underwent supratrigonal cystectomy with Hautmann pouch surgery.

Outcome Measures: Total continence rate, Surgery success, Maximum cystometric capacity (MCC), Mean compliance (MC), Mean detrusor pressure (MDP), Neurogenic detrusor overactivity (NDO), Complication rate, Incidence of bowel dysfunction.

  1. Continence was significantly improved for 52 of the 58 patients (89.7% (p<0.05)) and total continence was achieved in 74.1% of cases (N=43).
  2. Mean MCC and MC after treatment significantly increased (p<0.05).
  3. MDP before versus after treatment significantly decreased from 54.1 to 19.1cmH2O resp. (p<0.05).
  4. Persistent NDO was evident in 36 patients (59%) pre-surgery versus 12 patients (20.7%) post-surgery resp. (p<0.05).
  5. The overall surgery complication rate was 37.7% (N=23) of which 82.6% were ≤ grade 2 (N=19).
Gurung et al. 2012
UK
Case Series
N=19
Population: Mean age: 28.9 yr (range=12-52); Gender: male=12, female=7; Level of injury: Cervical=1, Thoracic=16, Lumbar=2; injury etiology: RTA (road traffic accident) (N=11), Fall (N=6), Gunshot (N=2); Mean time from injury to operation: 4.5 yr (range=0.3-22).

Treatment: Patients underwent augmentation ileocystoplasty (AIC), with follow-up at 3 mo, 1 yr, 5 yr and <10 yr.

Outcome Measures: Maximum cystometric capacity (MCC), Maximum detrusor pressure (MDP), Quality of life (QoL).

  1. Of the 26 patients who had undergone AIC before 1998, only 19 patients were available for long-term follow-up/analysis.Two of these patients died from unrelated causes.
  2. Of the 17 patients, continence was reported in 15/17 patients (vs 0 before surgery).
  3. MCC at the latest follow-up at>10 yr post-surgery increased significantly from an estimated preoperative mean of 229ml to a mean of 494ml (range=387-601 ml) (p<0.001).
  4. MDP at the latest follow-up at >10 yr post-surgery, decreased significantly from an preoperative value of 81cmH2O to a mean of 28cmH2O (range=15-40 cmH20) (p<0.001).
  5. Of the 14 patients who completed the questionnaire survey 13/14 were satisfied with the outcome such that they would consider undergoing the procedure again and would recommend it to someone else.
Reyblat et al. 2009
USA
Case Control
N=73
Population: SCI=68; Mean age: 34 yr; Gender: males=55, females=18.

Treatment: Charts were reviewed of patients who had previously undergone extraperitoneal augmentation (n=49) and intraperitoneal augmentation (n=24) to assess effectiveness.

Outcome Measures: Complication rate, operation time, bowel function, catheterization time.

  1. Overall complication rate was similar in both groups (Extraperitoneal 37% versus Intraperitoneal 42%).
  2. Intraperitoneal group had a significantly higher operation time than the extraperitoneal group (p<0.0001).
  3. Bowel function returned earlier in extraperitoneal group than the intraperitoneal group (p=0.0005).
  4. No significant difference was seen between the groups in mean time to catheter removal.

Chen & Kuo 2009
Taiwan
Pre-Post
N=40

Population: Mean age: 36.3 yr; Gender: males=36, females=4; mean follow up : 7.8 yr (range 1-14 yr); level of SCI – suprasacral: 33, sacral: 7; 95% of patient had incontinence.

Treatment: Augmentation Enterocystoplasty surgery.

Outcome Measures: Urodynamic variables; adverse events.

  1. The bladder capacity improved from 115 to 513mL postoperatively (p<0.0001).
  2. Bladder compliance also improved significantly (p<0.0001). Four patients could achieve continence while 29 required clean IC for bladder management.
Quek & Ginsberg 2003
USA
Case Series
N=26
Population: SCI patients with bladder augmentation: Mean age: 29 yr; Gender: males=18, females=8.

Treatment: Bladder augmentation with a minimum of retrospective review of 4 yr. The majority of patients had this done in conjunction with various other continence or antireflux techniques.

Outcome Measures: Bladder capacity, maximum detrusor pressure, subsequent operations, bowel function, UTI, complications, satisfaction. Mean follow up=8 yr.

  1. There was a signficant increase in bladder capacity from preaugmentation to postaugmentation (p<0.001).
  2. Mean maximum detrusor pressure decreased significantly (p<0.01).
  3. No significant changes in bowel function were seen in 23 patients.
  4. 88% of patients with previous symptomatic urinary infections had significant improvement in the frequency of infections.
  5. Patients were very satisfied with the bladder augmentation and would recommend it to a friend.

Nomura et al. 2002
Japan
Case Series
N=11

Population: SCI: Mean age: 29.0 yr; Gender: males=10, females=1; Level of injury: thoracic=11; Severity of injury: complete=10, incomplete=1; Injury etiology: trauma=10, transverse myelitis=1; Mean time post-injury=73.5 mo.

Treatment: Retrospective review of augmentation ileocystoplasty.

Outcome Measures: Bladder capacity, continence, complications.

  1. Bladder capacity significantly increased postoperatively (p<0.001).
  2. All patients showed improvement in urinary incontinence.
  3. Complications included:
  • Transient paralytic ileus occurred in 4 patients.
  • Wound infection occurred in 1 patient.

Chartier-Kastler et al. 2000b
France
Pre-Post
N=17

Population: Mean age: 36.5 yr; Gender: males=11, females=6; Level of injury: above T6=4, T6-T12=9, below T12=4; Severity of injury: complete=14, incomplete=3; Mean duration of SCI=7.5 yr.

Treatment: Patients underwent partial cystectomy with enterocystoplasty or detubularized clam cystoplasty.

Outcome Measures: Continence, maximal cystometric capacity, filling pressure, complications.

  1. 15 patients were completely continent postoperatively.
  2. A significant increase in maximal cystometric capacity by 191% was seen (p<0.05).
  3. Maximal filling pressure decreased by 72% (p<0.05).
  4. No complications were encountered.
top