Bladder augmentation and artificial sphincter implantation: Urodynamic behavior and effects on continence

Abstract 

Objective

To quantify changes in bladder capacity, pressure and compliance after isolated bladder augmentation or augmentation associated with implantation of an artificial sphincter, and to compare the various types of augmentation.

Patients and methods

Preoperative and postoperative urodynamic studies were performed in a group of 38 patients (18 males and 20 females; age range 2–19 years), who underwent a type of bladder augmentation.

Results

The bladder improved in capacity in all patients (mean values: initial 137ml, final 336ml, individual increase 229ml; 434%) except two, in which the augmentation was done with ureter. The mean pressure improved (initial 32cm of H₂O, final 14, decrease per patient 18cm of H₂O; 49%). The curve of compliance, progressively increasing typical of hyperreflexia and poor compliance, present in 70% of the cases preoperatively, improved in 78% cases postoperatively, although there were several different patterns. Urodynamic behavior was analyzed with regard to the tissue used for augmentation (ileum, ureter or sigmoid colon). In the sigmoid colon group, there were no significant differences in the urodynamic behavior of the bladder neo-reservoir in relation to the configuration used.

Conclusion

With bladder augmentation comes an increase in bladder capacity, a reduction in pressure, and an improvement in compliance and continence. The level of change in capacity, pressure and compliance varies with the tissue used and the length and caliber of the insert. When the procedure is carried out using sigmoid colon tissue, there are no noteworthy differences among the various possible configurations.

Keywords: Bladder augmentation, Urodynamics, Ileocystoplasty, Colocystoplasty, Ureterocystoplasty, Artificial sphincter