Further experience with seromuscular colocystoplasty lined with urothelium

Purpose: We report our continuing experience with seromuscular colocystopla sty lined with urothelium. This procedure is designed to preserve the uroth elium and potentially decrease the incidence of complications associated wi th standard bladder augmentation. Materials and Methods: We retrospectively reviewed the charts of 32 patient s who underwent seromuscular colocystoplasty lined with urothelium between April 1994 and July 1999. Data were collected on patient demographics, surg ical indications, previous and adjunctive surgical procedures, preoperative and postoperative urinary continence, upper urinary tract changes, urodyna mic parameters, surgical complications and histological findings. Results: Mean patient age at surgery plus or minus standard deviation was 1 1.1 +/- 4.8 years. Mean followup was 1.6 +/- 1 years. A mean of 1.5 +/- 0.9 years postoperatively urodynamic studies available in 28 cases showed that total and safe bladder capacity increased by 1.8 and 2.4-fold, respectivel y. Continence was achieved in 71% of patients after the initial procedure, increasing to 81% after secondary procedures. Hourglass deformity developed in 7 cases (22%), augmentation failed in 4 (12.5%) and there were bladder calculi in 2 (6%). New onset or increased hydronephrosis and reflux were pr esent in 6 of 62 (10%) and 9 of 60 (15%) evaluated renal units, respectivel y. Of the 7 interpretable biopsies 5 revealed various degrees of repeat col onic mucosal growth. There was no bladder perforation or metabolic abnormal ities, and mucous production was not clinically significant. Conclusions: Seromuscular colocystoplasty lined with urothelium is a viable alternative to standard bladder augmentation. The 2 procedures have a simi lar overall complication rate. Comparatively there appears to be a low inci dence of bladder calculi, mucous production has not been clinically signifi cant, metabolic disturbances have not developed and perforation has not occ urred during short-term followup. We are enthusiastic about this technique and continue to apply it in select patients.