Augmentation Enterocystoplasty: A Critical Review

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Abstract
An over-all success rate of 58.1% was achieved in 74 patients who underwent augmentation cystoplasty. Indications for the operation included a contracted bladder secondary to interstitial cystitis in 30 patients, defunctionalized bladder in 12, neurogenic bladder in 11, radiation cystitis in 9, tuberculous cystitis in 7, chemical cystitis in 4 and pericystitis in 1. Male patients did as well as female patients. Specific indications for the operation did not influence success rate, although augmentation cystoplasty used as part of a planned undiversion had a significantly lower success rate (45%) than when cystoplasty was used with an intact urinary tract (66.7%). The segment of bowel used did not influence results. Patients who underwent associated bladder neck revision did better, while no benefit was noted in patients who had a supratrigonal excision of the diseased detrusor. Complications were eliminated in 82% of the patients, while only 3 patients had progressive uremia. Operative mortality occurred in 2 patients (2.7%). Four other deaths occurred in the entire series, 1 1/2, 2, 5 and 11 yr later. Contraindications to the operation included patients with azotemia, vesical neoplasm, neurogenic bladder with spastic pelvic floor and some cases of defunctionalized contracted bladders. The pre-adolescent boy may have difficulty in voiding because of mucus. Patients with a strong psychiatric history should be approached with caution.