Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3240
Peer-review started: March 25, 2020
First decision: April 22, 2020
Revised: May 1, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: August 6, 2020
Augmentation cystoplasty increases bladder capacity, decreases bladder pressure, protects the upper urinary tract and enables the patient to acquire continence. Various segments of the gastrointestinal tract are used, but these segments are associated with mucosa-related complications. To preclude the contact of urine with the gastrointestinal mucosa, alternative methods were investigated, including urothelial augmentation, seromuscular bladder augmentation, auto-augmentation (AA), and seromuscular cystoplasty lined with urothelium (SCLU). The present study compared the outcomes of three different augmentation procedures. More data of the characteristics and indications of these procedures were reported, which may assist the selection of a particular procedure.
The principal procedure of AA is detrusorectomy, which resects part of the detrusor muscle to create a bladder diverticulum. For SCLU, detrusorectomy is performed first, after which the bulging urothelium is covered with a de-epithelialized patch of bowel. The two procedures were similar, but no reports compared their outcomes. Details about surgical techniques, outcomes, and complications are discussed.
The present study assessed the outcomes of patients undergoing AA and SCLU and determined whether SCLU provided better urodynamic results than AA. We compared the outcomes of patients who received SCLU and AA with patients who received standard cystoplasty (SC) to evaluate any augmenting effects and compared the results of SCLU with AA to ascertain the necessity of covering the seromuscular layer after detrusorectomy.
We performed a retrospective analysis of patients undergoing SC, SCLU, and AA.
SC provided sufficient bladder capacity and improved compliance with an acceptable level of complications. After AA and SCLU, patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation. AA may be temporally used in select patients to alleviate deterioration of the upper urinary tract. Compared with AA, SCLU did not yield better postoperative urodynamic parameters, which means that SCLU provided little benefit from the seromuscular layer covering the epithelium. The surgical techniques and postoperative management may require further adjustment, and longer follow-ups are needed.
The bladder capacity and compliance of patients after AA and SCLU were not satisfactory. Compared with AA, SCLU is a more complicated procedure and did not yield better postoperative urodynamic parameters. Cautious selection of the two procedures is suggested.
Autologous tissue remains the best option for bladder augmentation. All of the methods and materials have shortcomings. The surgical techniques and postoperative management require further adjustment. Biomaterials and tissue-engineered bladders are promising prospects.