Surgical complications of bladder augmentation: Comparison between variousenterocystoplasties in 133 patients

Objectives. Ileal and sigmoid augmentation are equally effective at increas ing bladder capacity and compliance. Therefore, knowledge of the incidence of major complications, including perforation, small bower obstruction (SBO ), anastomotic complications, calculus formation, and indications for revis ion may be useful in choosing the ideal segment. We compared the complicati ons of ileocystoplasty and two types of sigmoidocystoplasty that required r eoperative surgery. Methods. Between 1981 and 1997, 158 patients with a mean age of 11 years (r ange 2 to 25) underwent augmentation cystoplasty. Ileum or sigmoid colon wa s used in 133 patients, who were the subjects of this study. The mean follo w-up was 64 months (range 6 to 185). Indications included neurogenic bladde r (n = 100), bladder exstrophy (n = 12), cloacal exstrophy (n = 6), posteri or urethral valves (n = 3), and miscellaneous (n = 12). Ileum was used in 6 5 patients and sigmoid colon in 68. Of these, 48 underwent conventional col ocystoplasty and 20 seromuscular colocystoplasty lined with urothelium (SCL U). Seventy-nine percent required additional procedures to achieve continen ce or facilitate catheterization, which included bladder neck procedures in 56% or continent stomas alone in 23%. Results. There were no deaths or complications of bowel anastomosis. Overal l, continence was achieved in 95%. Spontaneous bladder perforation was high est in patients with neurogenic bladder. Calculi developed more frequently in patients with continent stomas (P = 0.04) and in patients with bladder/c loacal exstrophy (32%) than in patients with neurogenic bladder (P = 0.01). Additional procedures and route of catheterization did not increase the ri sk of perforation. One patient with SCLU with known hypercalciuria develope d bladder calculi. Conclusions. Sigmoid colon showed a trend of a lower rate of SBO with no di fference in perforation or stone formation compared with ileum. Primary dia gnoses of bladder or cloacal exstrophy and continent stomas are risk factor s for the development of calculi. SCLU has a low rate of surgical complicat ions and no incidence of perforation or SBO thus far; therefore, we advocat e the use of SCLU when feasible, and sigmoid as the preferred bowel segment for augmentation cystoplasty. (C) 2000, Elsevier Science Inc.