SURGERY FOR DETRUSOR OVERACTIVITY

Intractable detrusor overactivity can result in considerable morbidity and, in the case of neurogenic bladder dysfunction, can put the upper tracts at risk. Once conservative treatments have been exhausted the aim of surgery is to increase functional bladder capacity and decrease the maximal detrusor pressure at this capacity. The mainstay of conte mporary therapy has been augmentation cystoplasty; the different techn iques and recent literature are reviewed herein. Bladder autoaugmentat ion is compared and contrasted with augmentation cystoplasty and its r ole is discussed, as is the less invasive technique of sacral neuromod ulation with reference to their role within the range of surgical trea tments for detrusor activity.