LONG-TERM RESULTS AND COMPLICATIONS OF AUGMENTATION ILEOCYSTOPLASTY FOR IDIOPATHIC URGE INCONTINENCE IN WOMEN

Objective To assess the long-term (3-9 years) results of augmentation ileocystoplasty for non-neurogenic female urge incontinence in terms o f continence, the need for intermittent self-catheterization and the n eed for additional or auxiliary treatment, to define the long-term com plications and to assess the patients' satisfaction with the outcome. Patients and methods The study comprised 51 women who underwent augmen tation ileocystoplasty for nonneurogenic urge incontinence between Nov ember 1987 and December 1993; 27 patients had associated interstitial cystitis. All patients had exhausted conservative methods, with an uns atisfactory outcome. All patients were interviewed about the results o f the procedure. and their charts reviewed and updated with relevant i nformation. Results Within a mean (range) follow-up of 75.4 (36-109) m onths, 27 patients (53%) were completely continent, 13 (25%) had occas ional leaks and nine (18%) continued to have disabling urge incontinen ce frequently requiring pads. Regular self-catheterization was needed by 20 (39%) patients while the rest emptied adequately with no or mini mal residual volumes. Additional pharmacotherapy had to be used by 12 (24%) patients. Three patients later developed stress urinary incontin ence and were managed with fascial sling procedures, The patch was rev ised in two patients and excised from four others because they had hig h residual volumes and uncontrollable infections, Two patients had an ileal conduit diversion for persistent incontinence. The most common c omplication was recurrent urinary tract infections, seen in 22 patient s using intermittent self-catheterization. Mucus retention occurred re gularly in 10 patients, six had chronic diarrhoea, four had latent bow el obstruction, one developed a bladder stone, one an incisional herni a and one developed patch necrosis and perforation. Twenty-seven patie nts (53%) were happy with the outcome of the procedure while 20 (39%) were not: four patients were unsure whether a change had occurred. Con clusion Augmentation ileocystoplasty is a valuable alternative for wom en with intractable urge incontinence. However, these patients and the ir physicians should be aware of its limitations, specifically the pos sibility that incontinence may persist and the high probability of the need for self-catheterization, with potential subsequent urinary trac t infection.