Bladder augmentation: a treatment for neurogenic bladder dysfunction

DOI: 10.22591/magyurol.2018.1.kubika.12

Authors:
Kubik András dr., Keszthelyi Attila dr., Nyirády Péter dr., Majoros Attila dr.
Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)

Summary

Objective: Treatment of neurogenic bladder dysfunction is staggered, based on intermittent self-catheterization (CIC) in many cases. Unfortunately, over time either primarily or during progression in such cases urinary bladder becomes high pressured, reduced capacitated and expanded. If other minimal invasive treatments (such as clean intermittent catheterisation, anticholinergics, botulinum toxin, sphincterotomy) fail to reduce urinary bladder pressure and increase its capacity, compliance, then augmentation of bladder with excluded ileum section may result a good solution in high pressure reflux, renal impairment and recurrent urinary tract infections causing permanent disease.
Patients and methods: At our clinic, a 23-year-old and a 28-year-old female patient had open bladder augmentation due to neurogenic bladder dysfunction. In both cases, congenital spinal cord disorders (congenital sacrum agenesia or meningomyelocele) formed the basis for neurogenic bladder dysfunction. Conservative (anticholinergicum + CIC) and minimal invasive (botox intradetrusor injection) therapy was ineffective; bladder augmentations with excluded ileum sections were performed in both patients.
Results: Following the operation, the patients’ continence was improved, the numbers of urinary tract infections were decreased and their urinary bladder was still emptied by intermittent catheterization. The control urodynamic study demonstrated a significant increase in bladder capacity and compliance.
Conclusion: The first-line therapy, in many cases the base therapy for neurogenic bladder dysfunction is intermittent self-catheterization. If the conservative treatment does not manage to maintain low pressure, good compliance and capacity of the bladder, then augmentation of the urinary bladder is recommended with bowel application.

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