Medicinski vjesnik, Vol. 30 No. (3-4), 1998.
Professional paper
Augmentation enterocystoplasty in the treatment of neurogenic bladder dysfunction
Ivan Gilja
Radovan Deban
Berislav Mažuran
Marjan Radej
Marijan Kovačić
Abstract
The aim of this study was to estimate efficacy of augmentation cystoplasty in treating patients with clearly defined neurological lesions and consequent neurogenic urinary bladder. The augmentation cystoplasty was performed in 22 patients (21 male and 1 female) with neurogenic bladder dysfunction (14 war spinal cord injuries, 7 spinal cord injuries caused by car accident and 1 transverse myelitis). The augmentation cystoplasty was basically indicated in patients with severe detrusor hyperreflexia and / or poor bladder compliance and with progressive damage of the upper urinary tract despite aggressive pharmacological therapy and intermittent self-catheterization. Clam ileocystoplasty was performed in 20 patients whereas in two patients we used ileocecal segment with continent appendicistomy (Mainz 1). The first postoperative followup included clinical examination and urodynamic evaluation. It was performed 3 months postoperatively and the last followup was not performed until 18 months following surgery. The renal function as well as the upper part of urinary system showed improvement or stayed stable in all patients. An acid-base balance was normal in all of them. Three months following surgery all patients were continent daily, whereas 9 out of 22 patients experienced some episodes of nocturnal enuresis. At the moment of the last followup all 22 patients were continent during 24 hours every day with intermitent self-catheterization every 4-6 hours. Three months postoperatively urodynamic evaluation revealed significant enlargement of functional bladder capacity (310.00±78.31 ml related to preoperative volume of 129.55±56.01 ml; p<0.0001; t=8.790 unpaired t-test). The last followup showed functional bladder capacity of 502.73±107.14 ml; significant enlargement related to either preoperative capacity or capacity measured three months postoperatively (p<0-0001; t=14.478 or p<0.0001; t=6.812, unpaired t-test). These results may suggest a time (more than 3 months) neede to reach a definitive pattern of augmented bladder behavior. Augmentation cystoplasty is a therapeutic modality that should be considered a viable treatment option in selected patients with neurogenic bladder dysfunction.
Keywords
augmentation enterocystoplasty; neurogenic bladder dysfunction
Hrčak ID:
192358
URI
Publication date:
1.12.1998.
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