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Prerequisite for successful surgical outcome in urothelium lined seromuscular colocystoplasty

 Hyun Jin Jung  ;  Hyeyoung Lee  ;  Young Jae Im  ;  Yong Seung Lee  ;  Chang Hee Hong  ;  Sang Won Han 
 JOURNAL OF UROLOGY, Vol.187(4) : 1416-1421, 2012 
Journal Title
Issue Date
Adolescent ; Adult ; Child ; Child, Preschool ; Colon/surgery* ; Female ; Follow-Up Studies ; Humans ; Male ; Muscle, Smooth/surgery* ; Remission Induction ; Retrospective Studies ; Serous Membrane ; Time Factors ; Urinary Bladder/surgery* ; Urinary Reservoirs, Continent* ; Urologic Surgical Procedures/methods* ; Urothelium/surgery* ; Young Adult
urinary bladder ; urinary incontinence ; urinary reservoirs ; continent ; urodynamics
PURPOSE: Urothelium lined seromuscular colocystoplasty is an ideal method of augmentation cystoplasty that avoids various complications caused by the use of gastrointestinal segments. We reviewed the long-term outcomes using this technique at a single institution.

MATERIALS AND METHODS: We retrospectively analyzed 34 patients who underwent urothelium lined seromuscular colocystoplasty between January 1996 and December 2007. A total of 33 patients, excluding 1 who had previously undergone artificial urinary sphincter implantation, were included in the study. Changes in urodynamic parameters, duration of anticholinergic use, incontinence and surgical complications were analyzed.

RESULTS: Mean±SD age at surgery was 10.0±5.7 years (range 3.0 to 26.0) and duration of followup was 6.0±2.3 years (2.7 to 13.4). A total of 17 patients (51.5%) underwent simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty. Mean bladder capacity increased by a factor of 2.96 and mean percentage of expected bladder capacity for age increased by a factor of 1.96 postoperatively. Of patients who underwent anti-incontinence surgery 4 of 10 whose abdominal leak point pressure was less than 40 cm H2O required additional surgery, whereas none whose abdominal leak point pressure was 40 to 60 cm H2O required reoperation. Two of 16 patients who did not undergo anti-incontinence surgery eventually required continence surgery. A total of 13 patients (39.4%) were able to discontinue anticholinergics at 47.3 months postoperatively. There were no bladder perforations, bowel obstructions or metabolic abnormalities.

CONCLUSIONS: Urothelium lined seromuscular colocystoplasty can be primarily considered in patients without prior bladder mucosal injury. Constant high bladder outlet pressure to facilitate adhesion of bladder mucosa and seromuscular patch is critical for the best results. We recommend abdominal leak point pressure 60 cm H2O or less as an indication for simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Lee, Hye Young(이혜영)
Im, Young Jae(임영재)
Jung, Hyun Jin(정현진)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
Hong, Chang Hee(홍창희) ORCID logo https://orcid.org/0000-0002-0946-7702
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