Reconstructive surgery in voiding dysfunction: Experience with 69 patients

Objectives. To present our reconstructive surgery experience with voiding d ysfunction due to both neurologic and non-neurologic etiology. Methods. From March 1993 to January 2000, 69 patients (43 men and 26 women) with voiding dysfunction underwent lower urinary tract reconstruction. Mea n patient age at the time of surgery was 34.5 years (range 9 to 75). Voidin g dysfunction had a neurologic etiology in 65.2% of the patients and a non- neurologic etiology in 34.8%. Urodynamic investigation revealed poor bladde r compliance in 52%, detrusor hyperreflexia in 19%, and a combination of th e two in 29% of the patients. Thirteen patients (19%) had coexistent intrin sic sphincteric deficiency. A total of 56.5% of the patients had upper urin ary tract deterioration. Most patients (78%) had severe urinary incontinenc e, Augmentation cystoplasty was performed in 60 patients. Nine patients had augmentation cystoplasty with a continent stoma. Concomitant procedures we re performed in 11 patients. Results. Mean follow-up was 36.6 months (range 8 to 108). Marked improvemen t of the upper tracts was documented in 79% of the patients in the neuropat hic and 73% in the non-neuropathic group, High continence rates were achiev ed in both groups (82% and 94%, respectively). Intermittent catheterization rate was 88.6% in the neuropathic and 44% in the non-neuropathic groups an d patient satisfaction rate was 84% and 94%, respectively. Three major comp lications in 2 patients required surgery. Conclusions. Surgical reconstruction to treat urinary incontinence and uppe r urinary tract deterioration gives satisfactory results in voiding dysfunc tion in the case of medical treatment failure. UROLOGY 56: 962-966, 2000, ( C) 2000, Elsevier Science Inc.