Long-term results of augmentation cystoplasty in spinal cord injury patients

Study design: Prospective monocentric follow-up study. Objectives: To assess long-term functional and urodynamic results of augmen tation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperreflexia and reflex incontinence who failed to respond to conservativ e treatment. Settings: Department of Urology (Pitie-Salpetriere Hospital. Paris, France) , Department of Neurological Rehabilitation (Raymond Poincare Hospital, Gar ches, France), Assistance Publique - Hopitaux de Paris, University Paris VI and V, France. Methods: Prospective study of 17 SCI patients (four above TG level, nine be tween T6 and T12, and four below T12) with history of refractory urge incon tinence to pharmacotherapy. Partial cystectomy (subtrigonal for 15) was per formed with Hautmann enterocystoplasty (15) or detubularized clam cystoplas ty (two). Results: Mean follow-up was 6.3+/-3.8 years (range 1.25-10.5 years). Fiftee n of 17 (88.5%) patients were completely continent under self clean intermi ttent catheterization (CIC) (mean 4.6/day, range 4-7). The remaining two pa tients with pudendal nerve denervation had persistent stress urinary incont inence. No operative complications were noted. Long-term complications incl uded recurrent pyelonephritis for one patient. Maximal cystometric capacity increased from 174.1+/-103.9 to 508.1+/-215.8 mi (P<0.05). Maximal end fil ling pressure decreased from 65.5+/-50.2 to 18.3+/-7.9 cm H2O (P<0.05). Conclusion: Urodynamic evaluation and clinical assessment demonstrate long- term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients.