Outcomes of seromuscular bladder augmentation versus standard ileocystoplasty: A single institution experience over 14 years

SummaryIntroductionIleocystoplasty is the standard technique used for bladder augmentation, and has been used widely for decades. However, it is known to be associated with complications such as stone formation, mucus production, metabolic acidosis, urinary tract infections, intestinal obstruction, and a long-term risk of bladder cancer. Seromuscular bladder augmentation (SMBA) is an alternative to the standard ileocystoplasty, and has been associated with a lower incidence of bladder stones. Few reports have been published on intermediate outcomes of SMBA. Herein, we report long-term outcomes of SMBA from a single institution compared with standard ileocystoplasty.MethodsAfter Institutional Review Board approval, a retrospective chart review of all patients who underwent bladder augmentation at our institution over a 14-year period was performed. The status of patients after SMBA (10 patients) was compared according to age, sex, and diagnosis with patients who underwent traditional ileocystoplasty (30 patients). Parameters such as demographic information, pre- and postoperative bladder capacity as assessed by urodynamic studies, urinary tract infections (UTIs), bladder calculi, incontinence, need for secondary surgical procedures, and spontaneous bladder perforation were compared in the two groups. All the patients were on a clean intermittent catheterization (CIC) regimen.ResultsOver the study period, 10 patients underwent SMBA and 30 patients (according to age, sex, and diagnosis) underwent standard ileocystoplasty; the average age at surgery was 10.3 and 10 years respectively, with a mean follow up of 6.7 years in the SMBA group and 6 years in the ileocystoplasty group. There were no statistically significant differences in the rate of UTIs, urinary incontinence, subsequent surgery, or spontaneous bladder perforation. The mean bladder capacity increased significantly for both groups as assessed by pre- and postoperative urodynamic studies, although the difference in the rate of bladder calculi between the two groups (0 [0%] vs. 8 [27%], p = 0.06) did not reach statistical significance (Table).ConclusionsSMBA is safe and efficacious and may result in a lower rate of stone formation than standard ileocystoscopy. SMBA should be considered as a viable alternative to standard ileocystoplastyTable. Outcome comparison: SMBA versus standard ileocystoplasty.SMBA (n = 10)Ileocystoplasty (n = 30)pMean preoperative bladder capacity, mL (nA = 8, nB = 19)121 ± 93153 ± 1300.26Mean postoperative bladder capacity, mL (nA = 4, nB = 14)400 ± 241378 ± 1530.42Mean time of postoperative urodynamics51 ± 4450 ± 280.47Urinary tract infections3 (30%)8 (27%)0.8Bladder calculi0 (0%)8 (27%)0.06Incontinence2 (20%)11 (37%)0.3Spontaneous bladder perforation1 (10%)0 (0%)0.07Secondary surgery1 (10%)7 (23%)0.4 Re-do augmentation0 (0%)2 (7%) Stone surgery0 (0%)5 (17%) Bladder rupture repair1 (10%)0 (0%).