BERKELEY, CA (UroToday Inc.) - Jerry Blaivas and colleagues from New York reviewed their long-term outcomes after augmentation enterocystoplasty (AC) and continent diversion (CD) for benign disease. Their results were published in the May 2005 edition of the Journal of Urology.

They performed a multi-institutional review of 76 consecutive patients who underwent a simple AC (n=50), AC with abdominal stoma (n=15), or a CD (n=11). Their preoperative diagnoses were as follows: neurogenic bladder in 41 patients, refractory detrusor overactvity in 9 patients, interstitial cystitis in 7 patients, end stage bladder disease in 7, radiation cystitis in 3, exstrophy in 3, postoperative urethral obstruction in 3, and low bladder compliance in 3. These patients consisted of 58 women and 18 men with a mean age of 49 (range, 19-80 years). 56 patients had more than 5 years of followup.

Overall there were 71 patients who had sufficient followup data to be evaluated. 70% (49/71) considered themselves cured, 18% (13/71) felt as though they were improved, and 13% (9/71) considered their surgery a failure. All the patients with a preoperative diagnosis of interstitial cystitis were considered failures, as they had continued pelvic pain and did not achieve adequate increases in bladder capacity.

Overall continence in 68 evaluable patients was complete in 74%, improved in 23%, and failed in 3%. Only 27% (3/11) undergoing CD had persistent incontinence. Mean bladder capacity increased from 166ml to 572ml, and mean maximum detrusor pressure decreased from 53 to 14 cm H2O.

Serum creatinine remained normal or improved in all but 2 patients. 7% (5/71) had new onset diarrhea requiring medication and none developed vitamin B12 deficiency, pernicious anemia, or clinically relevant malabsorption syndrome.

42% (11/24) of patients with a continent stoma developed stomal complications including stomal stenosis in 33% (8/24), incontinence in 13% (3/24). 17% (4/24) required reoperation for stomal stenosis. 6% (4/71) required surgical exploration for small bowel obstruction.

The authors conclude that AC and CD can be a safe and effective long-term treatment in patients with refractory neurogenic bladder problems. Neither surgery appears to be effective in the treatment of interstitial cystitis. Special care needs to be exercised when creating the continent stoma, as stomal complications are not infrequent.

J Urol 2005; 173:1631-1634