Institute of Urology, Division of Surgery and Interventional Science, University College London.
Department of Neuro-urology, Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore; Department of Statistics, Medical Research Council Clinical Trials Unit, London, UK.
Study Type - Therapy (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? Suprasacral spinal cord injuries can result in intractable detrusor overactivity adversely effecting patients' quality of life. It can lead to high pressure bladder resulting in urinary incontinence and deterioration of upper tract function. Augmentation cystoplasty is an accepted procedure in treating refractory neurogenic detrusor overactivity. Several publications have reported on the short- to intermediate-term outcomes with augmentation cystoplasty in patients with spinal cord injury. However, it is not known how these outcomes alter over a longer period. This study has a follow-up of at least 10 years. It evaluates the durability of this procedure over the longer term. It also assesses the patients reported outcome over this period. This data can help counsel patients better when considering augmentation cystoplasty as a treatment option for the management of refractory neurogenic detrusor overactivity secondary to spinal cord injury.Small cell carcinoma of the prostate is a lethal disease. Survival date is currently based on case reports and single institution case series which give limited information on its prognostic factors. In this large population-based study, we provide more robust estimates of survival and have defined the prognostic factors.
To report the long-term outcomes of augmentation ileocystoplasty (AIC) in patients with spinal cord injury (SCI), with a minimum follow-up period of 10 years.
We retrospectively analysed all operations performed by a single surgeon at a specialist spinal unit. Outcomes were measured by comparing preoperative and follow-up videocystometrograms (VCMGs). Complications were identified from case notes and the surgery database. Subjective assessment was through a previously validated questionnaire.
The mean (range) follow-up was 14.7 (10.5-20.3) years. There were 19 patients (12 males) with a mean (range) age at time of surgery of 28.9 (12-52) years. The mean (range) period from injury to surgery was 4.5 (0.3-22) years. All had suprasacral injuries. The VCMGs showed a significant improvement in bladder capacity and a decrease in intravesical pressures (P < 0.001). Long-term complications included bladder stones (n= 4); urosepsis (n= 2); vesico-ureteric reflux ([VUR]n= 2), VUR requiring ureteric re-implantation (n= 1); neurogenic detrusor overactivity ([NDO]n= 1); and laparatomy for bowel obstruction (n= 1). Surveillance cystoscopies did not detect any bladder neoplasms. The response rate for the questionnaire survey was 14/17; 13/14 patients were satisfied with the operation such that they would consider it again or recommend it to a friend. No patient reported any significant changes in either bowel habit or sexual function.
We found that AIC has excellent long-term outcomes in the definitive management of refractory NDO in patients with SCI. The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients.
Written by:
Gurung PM, Attar KH, Abdul-Rahman A, Morris T, Hamid R, Shah PJ. Are you the author?
Reference: BJU Int. 2011 Aug 18. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10509.x
PubMed Abstract
PMID: 21851549
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