URODYNAMIC COMPARISON OF ILEUM VS SIGMOID IN AUGMENTATION CYSTOPLASTYFOR NEUROGENIC BLADDER DYSFUNCTION

We performed multichannel urodynamics before and after augmentation cy stoplasty in 26 patients (11 females, 15 males) to determine which bow el segment is best to achieve a large volume and low pressure reservoi r. All 26 patients had a neurogenic cause for their bladder dysfunctio n. Ileum was used in 14 patients and sigmoid was used in 12 patients. Detubularization was performed in all patients. Capacity improved sign ificantly in both the ileum and the sigmoid group after surgery. When detubularized ileum was used, the maximum amplitude of uninhibited res ervoir contractions was significantly improved or eliminated postopera tively. When sigmoid was used, uninhibited reservoir contractions did not significantly improve postoperatively and were, in fact, more comm on than preoperatively. Despite the detubularization, pressure waves w ere identified in 15 of the 26 patients postoperatively. There was sig nificant improvement in end filling pressures at capacity (compliance) with both ileum and sigmoid postoperatively. However, end filling pre ssures were significantly higher in the sigmoid group. In conclusion, good capacity was achieved with both neum and sigmoid postoperatively. However, ileum provided lower reservoir pressures and better complian ce. We feel that urodynamically detubularized ileum is better suited t han sigmoid for augmentation cystoplasty in patients with neurogenic b ladder dysfunction. (C) 1995 Wiley-Liss, Inc.