LONG-TERM RESULTS AND COMPLICATIONS USING AUGMENTATION CYSTOPLASTY INRECONSTRUCTIVE UROLOGY

One hundred and twenty-two augmentation cystoplasties performed over a n 8-year period were reviewed. Mean age at surgery was 37 years (range 2-82 years). There were 82 female patients. The primary urodynamic di agnosis was reduced compliance in 92 (77%) patients and detrusor hyper reflexia/instability in the remainder. The clinical diagnostic groups were: spinal cord injury/disease in 32 (27%), myelodysplasia in 27 (22 %), interstitial cystitis in 21 (17%), idiopathic detrusor instability in 13 (11%), radiation cystitis in 8 (7%), Hinman-Allen syndrome in 5 (4%), and miscellaneous in 11 (9%). A detubularized, ileal augmentati on was used in 82 (67%) patients. In 36 (30%) a detubularized ileoceco cystoplasty was fashioned and in the remainder detubularized sigmoid w as used. In 19 patients augmentation accompanied undiversion. Sixteen patients had a simultaneous fascial sling for urethral incompetence. M ean follow-up was 37 months (range 6-96 months). There was no postoper ative mortality. During follow-up 4 patients died from unrelated cause s, 11 have been lost to follow-up, and 5 patients await planned transp lantation. Bladder capacity was increased from a preoperative mean of 108 mi (range 15-500 mi) to 438 mi (200-1,200 mi) postoperatively. Of the 106 assessable patients, 80 (75%) had an excellent result, 21 (20% ) were improved, and 5 (5%) had major ongoing problems. During the per iod of follow-up, 17 (16%) patients underwent revision of their augmen tation. Twenty-four (21%) patients developed bladder stones and 30% of these did so more than once. Urinary incontinence became manifest in 15 (13%) patients but required surgical treatment in only half of thes e. Pyelonephritis occurred in 13 (11%) patients. Five patients develop ed small bowel obstruction following discharge from hospital. There we re 7 instances of reservoir rupture in 5 (4%) patients. Augmentation c ystoplasty has a pivotal role in the treatment of a broad range of low er and upper urinary tract problems. Careful patient selection and clo se follow-up are essential. (C) 1995 Wiley-Liss, Inc.