Augmentation Cystoplasty: Long-Term follow up Of 112 Cases

PurposeThis paper reviews a single center experience of augmentation cystoplasty cases.Material and MethodsOf the 145 patients who have undergone augmentation (AG) cystoplasty between 1994 and 2006, 112 (54 M 58 F, mean age 10.5 years (3-25), were available for long term follow-up, with a mean follow-up period of 42 months (12-114). Indications for AG were: neurogenic bladder (n = 79), undiversion (12), bladder exstrophy (8), posterior urethral valve (8), and Hinman syndrome (5). Ileocystoplasty was done for 65 cases, autoaugmentation (AA) for 34 cases, gastrocystoplasty in five, and ureterocystoplasty in eight cases. Additional procedures included: Mitrofanoff (57), sling or bladder neck reconstruction (23), and anti-reflux (AF) procedures (25).ResultsContinence was achieved in 74% with augmentation, and 91% with additional procedures. The average bladder capacity was 41% of the capacity expected for age and mean compliance was 4 ml/cmH₂O which were increased to an average of 85% and 12.9 ml/cmH₂O respectively. The improvement in capacity and compliance with AA was the lowest. Of the 67 patients with VUR, 25 had an AF procedure with a success rate of 84% (21/25). In the remaining 42, reflux was not corrected surgically, and 20 had no reflux following augmentation procedure (47.6%), 13 persisted (31%), 6 had downgrading (14.3%), 3 had unilateral resolution (7.1%). Overall complications were seen in 30.4%. The most common complication was pyelonephritis in 7%, 8 patients required revision of Mitrofanoff stoma, bladder stones were in 3.6%. The remaining complications were all minor seen in 1-2% each.ConclusionsIleocystoplasty is still considered the first choice if the prerequisites of uroepithelial cystoplasty are absent. AA should be restricted to the detrusor hyperactivity group, AF procedure should only be done in high grade reflux and good care must be considered in the presence of previous pelvic surgery.