ALTERNATIVE TECHNIQUES FOR AUGMENTATION CYSTOPLASTY

Purpose: We discuss conventional intestinal cystoplasty and show how c oncern about potential complications has led to an interest in alterna tive methods for cystoplasty, Techniques such as gastrocystoplasty, ur eterocystoplasty, vesicomyomectomy (autoaugmentation), seromuscular au gmentation, alloplastic replacement and bioprosthetic materials are re viewed. Laboratory and clinical results of these techniques are examin ed critically to compare advantages, disadvantages and potential appli cations. Materials and Methods: Computer searches of available medical data bases were used to generate a list of relevant publications, inc luding original contributions and review articles, which were then rev iewed, compared and summarized. Results: Augmentation cystoplasty is u sed routinely for treatment of reduced bladder compliance and capacity secondary to infectious, inflammatory, neurogenic and congenital diso rders. Sigmoidocystoplasty and ileocystoplasty have became standard te chniques but there is renewed interest in alternative techniques due t o the relatively high morbidity of intestinal cystoplasty. Alternative techniques have been described to avoid inclusion of intestinal mucos a in the urinary tract while creating a compliant bladder of adequate capacity. These techniques include gastrocystoplasty, vesicomyotomy, s eromuscular augmentation, various alloplastic or biodegradable scaffol ds and in vitro culture with subsequent grafting of autologous urothel ium. Although encouraging animal and human results have been reported, each technique is associated with its own limitations and disadvantag es. Conclusions: While intestinal cystoplasty remains the standard, se veral alternative techniques show promise. At present only gastrocysto plasty, ureterocystoplasty and seromuscular augmentation should be con sidered clinically useful.