|Year : 2013 | Volume
| Issue : 4 | Page : 328-337
Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction
EU Johnson, Gurpreet Singh
Department of urology, Southport Hospital, Merseyside, Southport Regional Spinal Injuries Unit, Merseyside, PR8 2JA, United Kingdom
|Date of Web Publication||21-Oct-2013|
Southport Regional Spinal Injuries Unit, Merseyside, PR8 2JA
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction.
Keywords: Botulinum toxin, clam augmentation, clam cystoplasty, conduit urinary diversion, continent diversion, detrusor myomectomy, enterocystoplasy, ileocystoplasty, long-term outcome, neobladder, neurogenic, reconstruction, review, sphincterotomy, spinal cord injury, urethral stent, urinary tract dysfunction
|How to cite this article:|
Johnson E U, Singh G. Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction. Indian J Urol 2013;29:328-37
|How to cite this URL:|
Johnson E U, Singh G. Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction. Indian J Urol [serial online] 2013 [cited 2020 Aug 6];29:328-37. Available from: http://www.indianjurol.com/text.asp?2013/29/4/328/120116
| Introduction|| |
Neurological lesions resulting in lower urinary tract dysfunction include peripheral lesions such as myelomeningocele, sacral agenesis, diabetes and sacral/spinal injuries; spinal lesions such as spinal injuries, tumors and infarctions; progressive lesions such as multiple sclerosis and myelitis; and intracranial lesions such as cerebrovascular disease, trauma, dementia, encephalitis, Parkinson and Shy Drager syndrome. This list is not exclusive. As the premise of this review is long-term outcomes, we will concentrate on pathologies where evidence of long-term outcome is available and these include spinal injuries and spina bifida.
Spinal cord injury (SCI) has been mentioned in the Edwin Smith papyrus as "an ailment not to be treated" and this sentiment prevailed until after the second world war when, the advent of specialized spinal units by Guttmann in Britain; Bors in the US, made long-term survival a reality. Even then, it was realized that mortality in the spinal injured patient was directly related to bladder physiology. 2% of patients with "balanced bladders" compared with 31% with unsatisfactory bladders, die of renal failure.  Factors responsible for improved morbidity and reduced mortality include intermittent catheterization and catheter free management; infection control and judicial use of antibiotics; and the advent of urodynamics with a better understanding of bladder physiology. In the last three decades, there has also been a greater understanding of the dynamic pathophysiology of neurogenic lower urinary tract dysfunction.  This has in turn led to an increase in quality and choice of management modalities offered to these patients. With wide use of intermittent catheterization, these modalities also include complex reconstruction options. The treatment approach adopted in managing these patients is often multifaceted but tailored to the unique needs of each individual with variable outcomes. , Therapeutic success is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of the agreed outcome measures and the prevention of serious complications. , The primary goal in neuropathic bladder management is protecting the upper tracts and reducing complications; achieving continence is a secondary goal.
Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary infections.
Surgical intervention is usually considered after exhausting less invasive options or if the patient's condition precludes such measures. The main indication is to protect or preserve renal function and to reduce the complications like recurrent infections. A secondary indication is to treat intractable urinary incontinence. Although the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK (due in part to the advent of effective minimally invasive therapeutic procedures as well as neuromodulator interventions), there is still a role for such operations. ,
There is an ongoing debate on options in the surgical management of these patients.  The considered options range from relatively simple measures such as sphincterotomy to more complex operations like urinary diversion or bladder reconstruction depending upon the urodynamic assessment of bladder dysfunction and treatment goals. Surgical interventions usually involve anatomic reconstruction; these are often complex, potentially high risk operations. ,, Most reports detail short-term outcomes with reconstructive procedures among this cohort, but only a handful have published long-term outcomes. We present a review of the published long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction.
The objective of this review is to provide a comprehensive look at reported long-term outcomes after reconstructive surgery in patients with neurogenic urinary tract dysfunction and thereby identify optimal practice and common adverse outcomes.
| Methods|| |
We conducted a world-wide electronic literature search of all English language publications using PubMed, MedLine, ovid and the reference list of relevant articles containing keywords: Reconstruction, urinary tract dysfunction, neurogenic, SCI, sphincterotomy, urethral stent, botulinum toxin, continent diversion, conduit urinary diversion, detrusor myomectomy, ileocystoplasty, clam cystoplasty, clam augmentation, enterocystoplasy, neobladder and long-term outcome. Initial review of 2103 results led to 102 full text articles meeting the selection criteria. Articles on children (<16 year); and those with a mean follow-up of less than 36 months were excluded.
In 2008, Neurourologists from the 11 spinal units in the UK published guidelines for the urological management of spinal injury patients.  Immediate, early, intermediate and long-term management was considered. Management follows one of three broad options; continence, contained incontinence or indwelling catheters/ostomy. Reconstruction of the neuropathic bladder should be the only long-term management option and; depends upon the nature of the lesion, on the abilities of the patient, on the time since the disability and most importantly should be tailored to the clinical picture, the social circumstances and the video urodynamics investigations.
Surgery is directed to the underlying problem. A failure to void could be helped by increasing detrusor contractions by sacral anterior root stimulator (SARS) or by reducing outlet resistance by sphincterotomy, stents or botulinum toxin. A failure to store can be helped by decreasing uninhibited detrusor contractions or increasing sphincter resistance or by bladder replacement surgery. Indications depend upon the clinical picture including holistic care, urodynamic pathophysiology and the choice of intervention as desired by the patients. Procedure options depend upon a multitude of factors.
Long-term reconstruction outcomes are analyzed in an anatomically retrograde fashion beginning with reconstructive operations on the urethra.
Trans urethral external sphincterotomy
This endoscopic procedure is usually performed to relieve bladder outlet resistance and facilitate effective bladder drainage in men.  Following sphincterotomy, an external urine collection device becomes necessary, achieved by condom catheterization and possible only in men. Sphincterotomy is considered a management indication in treating refractory detrusor sphincter dyssynergia (DSD) or severe autonomic dysreflexia (AD) in male patients with SCI or spina bifida. First employed therapeutically in paraplegic patients by Ross et al.;  a resecting loop, laser or endoscopic knife is used to destroy the striated urethral sphincter, the preferred site of incision is at 12 O'clock position;  this was first described by Madersbacher and Scott. 
Short-term outcomes were very encouraging in terms of improved vesical drainage and reduction of urinary tract infections (UTIs), but more recent articles describing long-term outcomes have been less impressive. Upper tract function preservation appears to be better when intervention is performed early, however reoperation rates can exceed 50%. ,,,,, Laser sphincterotomy appears to have a better out come in this regard.
Perkash  reported long-term outcomes on 46 male patients with supra T6 SCI and frequent episodes of AD. These patients were followed-up for between 1 and 12 years. He was able to show a significant reduction in blood pressure (P < 0.0001) and this correlated with a subjective relief in episodes of AD; and a significant reduction in post-void resides.
The main complication of external urethral sphincterotomy is a relatively high failure rate (36-49%) as reported by Yang and Mayo, and Santiago. , Their results were independent of selection criteria such as: age at operation, level of injury, previous bladder neck/sphincter operations, pre-operative maximum detrusor contraction pressures or time to maximum pressure. Reported reoperation rates can be as high as 66% often within the 1 st year. Other long-term complications include chronic urine leakage and pressure sores. 
Following a mean follow-up of 11 years, Juma et al. found asymptomatic bacteriuria in 76%, impaired renal function in 3.2%, detrusor hyperreflexia (95%), DSD (54%), significant upper tract complications (30%) and lower tract complications such as bladder neck stenosis (48%). 
Others complications include bladder neck obstruction or urethral stenosis ,,, (3-48%), risk of cutaneous skin breakdown and urethral fistula from long-term usage of a condom catheter.
Accounts of erectile dysfunction with the loss of reflex erections are reported in the short-term. This, as well as the advent of other reconstructive modalities, has resulted in a significant fall in the incidence of sphinterotomies in current neuro-urological practice.
Urethral stents were first used to treat urethral strictures in the late 1980s.  Indications later expanded to include patients with bladder outlet obstruction that were unsuitable for surgery. 
In neuropaths with DSD, external sphincterotomy remains the gold standard for patients with high voiding pressures with, urethral stents used as an alternative measure. 
Reported outcomes are mostly short-term, ,, but some long-term studies report up to 13% reduction in AD episodes.  Complications include bladder neck obstruction/stenosis (3.5-42%), stent migration (5-33%), calculi (6-20%), and stent telescoping (16-25%). ,,
The attraction of urethral stents in neuropaths is its reversibility.  There appears to be an inverse relationship between the time from SCI to stent insertion and duration of stent tolerance.  Rarely employed stents for DSD are not recommended under the current EAU guidelines. 
Botulinum neurotoxin A
Botulinum toxin is produced by the microbe clostridium botulinum and was first isolated in 1897 by van Ermengem.  It is one of the most potent naturally occurring toxins known to man. Botulinum neurotoxin A is the most clinically relevant subtype.  It acts as a reversible inhibitor of neurotransmitter (mainly acetylcholine) release at the neuromuscular junction of both striated and smooth muscle. Indications include DSD, idiopathic and neurogenic detrusor overactivity (NDO).
When employed in patients with DSD, small amounts are injected transurethrally into the external striated urethral sphincter.  Long-term outcomes are unavailable, but short-term results are encouraging. 
In 2000, Schurch et al. performed the first intradetrusor injections to treat incontinence due to overactive bladder in adult SCI or multiple sclerosis patients  and short-term outcomes have been published by various groups advocating the efficacy of this treatment in maintaining sustained control of incontinence, protection of upper urinary tract and reduction of urinary infectious complications. The largest was from a European group in 2004.  Re-injections do not appear to reduce the efficacy and this modality has found favor both with patients and their treating clinicians. To the best of our knowledge, published long-term outcomes are still awaited.
Tanagho and Schmidt first described sacral neuro-modulation as a means of treating refractory voiding dysfunction in 1988.  The modern day technique consists of posterior sacral rhizotomy (S2-4) with implantation of an electrical stimulation device on the corresponding anterior sacral nerve roots. Various studies show improved bladder emptying and quality-of-life with symptom relief (reduction in UTIs, incontinence, AD) in patients with suprasacral SCI.
Published long-term outcomes involve a heterogeneous patient population with a paucity of outcomes for pure neurogenic patients. Available reports show improved continence (80-90%), decrease episodes of UTI (up to 81%) and improved quality-of-life (up to 90%). These effects continue in most cases unless there is device failure or neurological progression. Reported long-term complication rates are between 22% and 43%; and include infection, pain, mechanical faults or device failure, which appears to be time dependent; difficulty operating the implant and implant automaticity. ,,, Reoperation rates are between 6% and 50%. ,,
SARS implantation remains a treatment option in a select group of patients, unwilling or unable to do intermittent self-catheterization (ISC) and willing to accept complications including sexual and bowel effects of the device.
Artificial urinary sphincter (AUS)
In patients with neurogenic sphincter weakness incontinence requiring surgery, the gold standard remains an AUS implantation. Pre-implantation exclusions are cognitive impairment or upper limb paresis.
The AUS has undergone various developmental modifications since Scott first introduced it in 1973.  The current version is the (American Medical Systems) 800 which consists of a urethral/bladder neck cuff, an inflation/deflation bulb and a pressure regulating balloon reservoir. The tubing is kink resistant, the connectors are suture-less and the cuff is flattened for added comfort and ease of implantation. , Careful patient selection is mandatory as is post implantation surveillance. Detrusor over activity, as high as 47%, has been reported in some series. 
Long-term results are very satisfactory. Chartier Kastler et al. reported 74% continence rate in a multicenter study involving 51 patients with an average follow-up time of 83 months (6-208).  Other groups report continence rates between 77% and 92% at 4-5 years. ,
Complications include infection, (6-24%); ,, cuff erosion (5-8% over a 5 year follow-up period). Erosion is more common within the 1 st year of implantation and with the new flat back cuff the incidence appears reduced. ,, Infection and erosion inevitably lead to device explanation.
As with all implanted devices, mechanical failure remains a threat. The frequency of mechanical device failure appears to be more than that seen in non-SCI patients and increases with time. Reported incidence is 10-57% within 5 years. ,, Reoperation rate can be high (28-50% revision within a 5 year follow-up period); ,, and tend to increase with longer follow-up.
Voiding dysfunction post implant is common (incidence 73.8-78%) ,, and intermittent catheterization should be learnt pre-implantation. Anticholinergics may also be required to control unmasked detrusor overactivity or reduce high detrusor pressure post-implantation. Singh and Thomas reported 78.9% of their patients required anticholinergic post AUS implantation.  In the Neuropath cystoplasty could either be performed simultaneously with AUS cuff implantation with good outcome and no increase in infection or erosion; or become necessary later to treat hypo compliance and preserve upper tract integrity. Studies show up to 79% of neurogenic patients may require this additional intervention. ,
Bladder neck reconstruction
Some patients with neurogenic dysfunction may require bladder neck reconstruction to manage urinary incontinence if diagnostic video urodynamic studies point to an incompetent bladder neck. Bladder neck reconstruction may also be performed in conjunction with augmentation cystoplasty.  Treatment needs to be individualized and some authors believe that good outcomes are solely due to bladder augmentation. ,,,
Numerous reconstructive techniques have been described. These include urethral bulking procedures, colposuspensions, transvaginal/mid urethral tapes (autologous or synthetic), flap valve reconstruction or AUS implantation. The precise technique chosen has to fit the patient's presentation and expectations after careful investigation and frank discussion with the patient. With the exception of an AUS, most published long-term outcome data involving bladder neck reconstruction in neuropaths are in the pediatric age group.
Bladder neck closure
Bladder neck closure needs to be combined with reconstruction with a catheterizable stoma. Shpall and Ginsberg reported one of the largest series reporting long-term results following bladder neck closure and lower urinary tract reconstruction in 39 patients with neurogenic voiding dysfunction.  The average follow-up period was 36.9 months and nearly half of their patients had concomitant augmentation enteroplasty with continent cutaneous stoma construction. All patients had good preservation of upper tract status. The most common post-operative complication was the formation of a vesicourethral fistula in 15% of patients. They concluded that bladder neck closure with simultaneous urinary diversion was a highly effective, well-tolerated treatment in neuropaths with an acceptable complication rate and current practice appears to support this with the exception of synthetic slings that have a higher erosion rate.
Zommick et al. reported results of continent urinary diversion in 28 patients (average follow-up 59.5 months). Nearly, 95% required long-term post-operative catheterization either by self or by a caregiver. Among the 21 patients who responded to their survey questionnaire, 80% reported a high level of satisfaction and an improved quality-of-life due to a post-operative improved sense of body image and freedom from urinary drainage bags. Success following these procedures requires a dedicated team working in specialized centers.
As with permanent urethral catheters, long-term management of the neuropathic bladder with a suprapubic cystostomy is fraught with problems. A Bristol (UK) group performed transvaginal urethral closure with concomitant suprapubic cystostomy in 50 women with multiple sclerosis and reported 79% continence after a follow-up period of 6.5 years (average). Secondary revision was attempted in 10%. Urinary diversion was performed in 4% and a return to urethral catheterization in 2%. The main complication was from recurrent bladder calculi and catheter encrustation  Nomura et al. reported stone free rates of 77% and 64%, 5 and 10 years post cystostomy.  Colli and Llyod achieved 97% continence (8.6% requiring a second operation) and 17% overall complication rate.  In conclusion, indwelling catheterization through suprapubic approach has the potential for controlled continence with some increase in long-term morbidity.
Smith and Hinman introduced the incontinent ileovesicostomy in the 1955  and in the mid-1990s McGuire popularized this as a surgical option for patients with neurogenic voiding dysfunction who were unable to perform clean catheterization due to body habitus, limited manual dexterity, cognitive impairment or other reasons.  Long-term indwelling catheterization is considered an alternative last resort in these patients.  Also named the bladder chimney operation, studies reporting long-term outcomes are scarce. Leng et al. and others published long-term reviews suggested low morbidity outcomes with an overall improvement in renal morphology and function. ,,,
However later reports , suggest higher morbidity; with 50-54% requiring further surgical intervention and 54-83% infection or stoma problems. Stomal stenosis rates as high as 15% have been reported. 
It is generally agreed that incontinent ileovesicostomy may be useful in neuropaths who are unable to perform clean intermittent catheterization or when their general health precludes major reconstruction and, after exhausting more conservative options. Among these patients, long-term problems often arise from either the neurogenic voiding dysfunction and/or the constructed ileovesicostomy; hence close long-term surveillance is advocated.
Conduit urinary diversion (Ileal conduit)
Conduit urinary diversion remains a good option for the management of neurogenic voiding dysfunction where problems such as hypocompliance with upper tract deterioration or total urinary incontinence may be prevalent. The ileal conduit, introduced by Bricker  has stood the test of time due to its relatively shorter construction time and familiarity among urologists. , The conduit allows for low-pressure urinary drainage. Very early published long-term outcomes from the 1970s were poor.  Moeller and Comarr reported good to a fair outcome in only about 50% of patients with 25% mortality mainly from urinary tract complications. , Koziol and Hachler also reported 25% mortality most of which occurred several years after the procedure and attributable to recurrent UTIs.  More recent studies though have published better outcomes with satisfactory renal function preservation in up to 100% in some series. ,,, Patient satisfaction recorded at 88-100%.  These excellent results are however not reproducible across the board and long-term outcome review indicate a high complication and reoperation rate. Some of the major long-term complications encountered with ileal conduit diversion in neuropaths include:
As high as 52% in cases where a concomitant cystectomy was not carried out. ,,,, This was managed by periodic bladder irrigation, iatrogenic vesicovaginal fistula formation and cystectomy were conservative methods had failed to treat the condition adequately.
Long-term stoma problems were reported among 6-37% of patients. The most common complications reported include bleeding, skin irritation, parastomal hernias, incisional hernias, prolapse, stenosis, ileo-ureteric anastomotic stricture and retraction of stoma. ,,, Conduit obstruction may result in upper tract dilatation and earlier series had a reoperation rate as high as 65%.  More recent studies however, report much lower reoperation rates (3-8%); , due to improved technique, imaging at follow-up and general perioperative fitness of patients.
This has been reported as a major concern in up to 12-60% of patients not only in the short-term; but also as a long-term complication. ,,,
This is an inevitable outcome in cases where bowel is harvested and used as a bladder substitute. In ileal conduits, acute hyperchloremic acidosis is rare, but chronic metabolic acidosis has been reported in up to 20% of patients. 
Calculi formation has been reported in 28-43% of patients. ,, These are often located in the kidney, but may form anywhere along the renal tract including the conduit. Predisposing factors include UTI, ureteric dilatation, urine stasis and metabolic acidosis.
Sekar et al. studied the renal function of over 1,000 SCI patients pre and post ileal conduit formation and noted that there were no clinically meaningful differences in the change in renal function over time among persons using different bladder management methods.  Renal function was adequately preserved in the great majority of neuropathic patients and did not appear to be influenced to any great extent by methods employed in bladder management.
Ileal-conduit formation is safe, relatively well-tolerated and can be cautiously considered as an option in the urinary management of patients with neurogenic dysfunction, particularly when more conservative management strategies have proved unsuccessful.
Auto-augmentation (detrusor myectomy/myotomy)
The introduction of detrusor myectomy or bladder auto-augmentation, by Cartwright and Snow, offered an innovative alternative for managing refractory detrusor overactivity.  By excising a disc of detrusor muscle to create a large diverticulum of the bladder dome, bladder storage function could be appreciably improved. Since its introduction, several modifications in technique have emerged with variable results. Most of the published series are in children with very few among the adult population and less so among the neurogenic or SCI cohort. ,,,, McDougall et al. were among the earliest to perform this procedure laparoscopically in a SCI patient and publish the short-term outcome demonstrating urodynamic evidence of improvement.  Some patients may show signs of improvement post-operatively, but this is not always backed up by objective urodynamic changes. 
The time lapse between auto-augmentation and functional rehabilitation of the bladder (substantial increase of capacity and detrusor compliance) is difficult to determine but may take up to 6 months.  The long-term physiologic condition of the mucosal diverticulum is unknown, but it has been speculated that ultimately the diverticulum will undergo fibrosis or that muscular regrowth may occur.  Up to 60% of SCI patients will require ISC post-operatively. Bladder rupture was reported in 2% of patients undergoing autoaugumentation. The predisposing factor for the rupture was thought to be the presence of an AUS. 
Results are not durable and further adjunct operations may be needed in up to 50% of cases. , Most series with a relatively long mean follow-up period (±6 years) do not appear enthusiastic about auto-augmentation, concluding that it is urodynamically and symptomatically inefficacious in the long run when managing patients with neurogenic voiding dysfunction.  The attractiveness of auto augmentation lies in the fact that it has comparatively less morbidity than enterocystoplasty and it does not preclude performance of an enterocystoplasty if required in the future.
Von Mikulicz described the first human augmentation ileocystoplasty in the latter part of the 19 th century.  A 100 years later, Bramble published his experience using the procedure to treat adult enuresis and urge incontinence.  With recent improvements in both laparoscopic and robot assisted techniques, augmentation cystoplasty has been performed in selected centers using these methods. ,,,
The vast majority of procedures are through the standard open technique and for these, long-term results have been published. Where available, ileocystoplasty appears to be the most popular bladder augmentation procedure in this cohort. Linder et al. were amongst the earliest to report intermediate to long-term results of reconstructive surgery (caecocystoplasty/ileocystoplasty) in patients with neurogenic bladder dysfunction. Eighteen patients were followed-up post-operatively for between 12 and 120 months (mean 38 months). Of this number, 5 had AUSs in addition to enterocystoplasty to aid continence. At the end of the follow-up period, 82% of the patients were continent.
Gurung et al. reported outcomes post augmentation ileocystoplasty in 19 patients (mean follow-up 14 years) with refractory NDO due to suprasacral SCI. These were relatively young patients with a mean age of 28.9 years. A single surgeon performed all operations. Evaluation was conducted using results of pre- and post-operative videocystometrogram and patient satisfaction was surveyed with a validated questionnaire. This group reported significant post-operative improvement in bladder capacity and a decrease in intravesical pressures (P < 0.001). Long-term complications were found in 57.9%. Nearly half of these were bladder stones (n = 4); others include urosepsis (n = 2); vesico-ureteric reflux (n = 2), ureteric re-implantation due to reflux (n = 1); NDO (n = 1); and laparatomy for bowel obstruction (n = 1). No patient developed bladder neoplasia during the follow-up period. Fourteen patients responded to the questionnaire with 93% indicating a high level of satisfaction. No patient reported any significant change in either bowel habit or sexual function. These are excellent long-term results in, possibly, a small series done in a regional center. Quek and Ginsberg  also reported a high level of patient satisfaction post enterocystoplasty in 26 patients with neurogenic voiding dysfunction after a mean follow-up of 8 years. Functional outcome was evaluated via urodynamics. Around 96% demonstrated near or complete resolution of their pre-operative urinary incontinence as well as a significant increase in bladder capacity (P < 0.001) with a mean maximum detrusor pressure reduction of 61 ± 12 cm H 2 O (P < 0.01). Nearly 88% experienced no significant alteration in bowel habit and almost all reported extreme satisfaction with urological outcome. Of the 26 patients treated, 12 (46%) required a secondary procedure 4.4 years after the initial surgery. Similar reintervention rates (30% to 59%) were reported by Mast et al.,  Herschorn and Hewitt  and Andrew and Lloyd. 
Chartier-Kastler's group performed their urodynamic assessment on a cohort of 17 patients after a mean follow-up of 5.4 years. 15 (88.5%) patients had a Hauntmann enterocystoplasty and the remainder a clam cystoplasty. Both groups reported very similar urodynamic and clinical outcomes.  Maximum cystometric capacity (MCC) increased from 174.1 ± 103.9 to 508.1 ± 215.8 ml (P < 0.05). Only two patients continued to have stress urinary incontinence. More recently, Gobeaux et al. published single center data detailing urodynamic and clinical outcomes from a similar procedure (± concomitant urinary incontinence surgery) among a larger group (61 patients) of SCI patients with NDO related urinary incontinence and/or sphincter weakness incontinence.  With a mean follow-up of 5.84 years (range 1-20.5), an improved or total continence rate was achieved in 89.7% and 74.1%, respectively. Surgery failed (incontinence persisted) for 6 (10.3%) patients, three of whom had a simultaneous procedure for stress incontinence. On urodynamics, MCC increased from 305.2 ml to 509.4 ml (P < 0.05), mean compliance (ml/cm H 2 O) increased from 15 to 42.7 (P < 0.05) and mean detrusor pressure at MCC (cm H 2 O) fell from 54.1 to 19.1 (P < 0.05). Persistent NDO occurred in 20.7% compared with 59% pre-operatively (P < 0.05). The overall complication rate was 37.7% but ≤ Clavien Grade 2 in 82.6%. Notably, the incidence of bowel dysfunction, namely diarrhea and/or fecal incontinence was 27.5%. Concomitant outlet surgery was associated with increased morbidity as three (17.6%) complications led to re-intervention.
Robertson et al. agreed that bladder augmentation or substitution has a role in managing patients with neuropathic bladder dysfunction after publishing their post-operative urodynamic (conventional and ambulatory) and clinical outcomes on 25 patients followed up over an average of 4 years. All patients had a detubularized reservoir made of an ileal or ileocecal segment. An artificial sphincter was fitted in 24% of patients treatedand 8% underwent colposuspension. 40% reporting complete success and 52% excellent improvement. An honest report with good long-term results and showing that combining a colposuspension and an AUS insertion does not create additional problems.
Although minimally invasive procedures are gaining in popularity and acceptance, augmentation cystoplasty remains the gold standard in treating patients with refractory neurogenic voiding dysfunction, detrusor overactivity, hypocompliance and high resting intravesical pressure. The evidence indicates a high level of success with manageable long-term morbidities. Lifelong surveillance is advocated.
The new frontier
Long-term outcomes are beginning to emerge from exciting new alternatives in reconstructive surgery. Atala et al. reported recently on 3.8-year (mean) outcomes following bladder tissue reconstruction using autologous bioengineered bladder tissue in seven patients with myelomeningocele. 
Autologous urothelial and smooth muscle cells were seeded on a bladder shaped collagen scaffold in vitro in preparation for later reconstruction and implantation. Overall improvement in urodynamic parameters were reported as well as preservation of renal function and absence of commonly reported long-term complications.
| Conclusion|| |
There have been a lot of advances in reconstructive urological surgery since the days of 19 th century pioneers like von Mikulicz. Though minimally invasive procedures are becoming mainstream, there is still a place for reconstructive procedures whether open, laparoscopic or robot assisted.
Advances in tissue and genetic engineering and stem cell research hold the key to future exciting new developments in the field of reconstructive urological surgery. Such a rich plethora of reconstructive procedures affords this unique cohort of patients' greater choice and ultimately potentially improved long-term care with better long-term survival and improved quality-of-life.
| References|| |
|1.||Bors E. Bladder disturbances and the management of patients with injury to the spinal cord. J Int Coll Surg 1954;22:61-2. |
|2.||Wein AJ, Dmochowski RR. Neuromuscular dysfunction of the lower urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 10 th ed., Vol. 3. Philadelphia: Elsevier; 2012. p. 1924-5. |
|3.||Panicker JN, De Sèze M, Fowler CJ. Neurogenic lower urinary tract dysfunction. Handb Clin Neurol 2013;110:209-20. |
|4.||Mundy AR. Neuropathic vesicourethral dysfunction. Urodynamic and Reconstructive Surgery of the Lower Urinary Tract. London: Churchill Livingstone; 1993. p. 155-7. |
|5.||Zommick JN, Simoneau AR, Skinner DG, Ginsberg DA. Continent lower urinary tract reconstruction in the cervical spinal cord injured population. J Urol 2003;169:2184-7. |
|6.||Department of Health, UK. Hospital Episode Statistics. Department of Health, UK. Available from: http://www.hesonline.nhs.uk. [Accessed on 2013 March 11]. |
|7.||Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int 2012;109:1280-93. |
|8.||Abrams P, Agarwal M, Drake M, El-Masri W, Fulford S, Reid S, et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int 2008;101:989-94. |
|9.||Ross JC, Gibbon NO, Damanski M. Division of the external urethral sphincter in the treatment of the paraplegic bladder: A preliminary report on a new procedure. Br J Urol 1958;30:204-12. |
|10.||Kiviat MD. Transurethral sphincterotomy: Relationship of site of incision to postoperative potency and delayed hemorrhage. J Urol 1975;114:399-401. |
|11.||Madersbacher H, Scott FB. Twelve o′clock sphincterotomy: Technique, indications, results (Abbreviated report). Urol Int 1975;30:75-6. |
|12.||Noll F, Sauerwein D, Stöhrer M. Transurethral sphincterotomy in quadriplegic patients: Long-term-follow-up. Neurourol Urodyn 1995;14:351-8. |
|13.||Perkash I. Transurethral sphincterotomy provides significant relief in autonomic dysreflexia in spinal cord injured male patients: Long-term followup results. J Urol 2007;177:1026-9. |
|14.||Yang CC, Mayo ME. External urethral sphincterotomy: Long-term follow-up. Neurourol Urodyn 1995;14:25-31. |
|15.||Ricottone AR, Pranikoff K, Steinmetz JR, Constantino G. Long-term follow-up of sphincterotomy in the treatment of autonomic dysreflexia. Neurourol Urodyn 1995;14:43-6. |
|16.||Pan D, Troy A, Rogerson J, Bolton D, Brown D, Lawrentschuk N. Long-term outcomes of external sphincterotomy in a spinal injured population. J Urol 2009;181:705-9. |
|17.||Santiago JA. Sphincterotomy failure. J Am Paraplegia Soc 1993;16:164-8. |
|18.||Hansen M, Terris MK. Urinary diversion in the management of chronic perineal skin ulceration in spinal cord injured patients following sphincterotomy. Adv Exp Med Biol 2003;539:879-84. |
|19.||Juma S, Mostafavi M, Joseph A. Sphincterotomy: Long-term complications and warning signs. Neurourol Urodyn 1995;14:33-41. |
|20.||Hachen HJ, Ott R. Late results of bilateral endoscopic sphincterotomy in patients with upper motor neurone lesions. Paraplegia 1976;13:268-74. |
|21.||Chancellor MB, Rivas DA, Abdill CK, Karasick S, Ehrlich SM, Staas WE. Prospective comparison of external sphincter balloon dilatation and prosthesis placement with external sphincterotomy in spinal cord injured men. Arch Phys Med Rehabil 1994;75:297-305. |
|22.||Milroy EJ, Chapple CR, Cooper JE, Eldin A, Wallsten H, Seddon AM, et al. A new treatment for urethral strictures. Lancet 1988;1:1424-7. |
|23.||Williams G, Jager R, McLoughlin J, el Din A, Machan L, Gill K, et al. Use of stents for treating obstruction of urinary outflow in patients unfit for surgery. BMJ 1989;298:1429. |
|24.||Shah NC, Foley SJ, Edhem I, Shah PJ. Use of Memokath temporary urethral stent in treatment of detrusor-sphincter dyssynergia. J Endourol 1997;11:485-8. |
|25.||Sauerwein D, Gross AJ, Kutzenberger J, Ringert RH. Wallstents in patients with detrusor-sphincter dyssynergia. J Urol 1995;154:495-7. |
|26.||van der Merwe A, Baalbergen E, Shrosbree R, Smit S, Heyns C. Outcome of dual flange metallic urethral stents in the treatment of neuropathic bladder dysfunction after spinal cord injury. J Endourol 2012;26:1210-5. |
|27.||McFarlane IP, Foley SJ, Shah PJ. Long-term outcome of permanent urethral stents in the treatment of detrusor-sphincter dyssynergia. Br J Urol 1996;78:729-32. |
|28.||Gamé X, Chartier-Kastler E, Ayoub N, Even-Schneider A, Richard F, Denys P. Outcome after treatment of detrusor-sphincter dyssynergia by temporary stent. Spinal Cord 2008;46:74-7. |
|29.||Stohrer M, Blok B, Castro-Diaz D, Chartier-Kastler P, Denys P, Kramer G, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol 2009 Jul; 56: 81-8. |
|30.||van Ermengem E. Classics in infectious diseases. A new anaerobic bacillus and its relation to botulism. E. van Ermengem. Originally published as "Ueber einen neuen anaëroben Bacillus und seine Beziehungen zum Botulismus" in Zeitschrift für Hygiene und Infektionskrankheiten 26:1-56, 1897. Rev Infect Dis 1979;1:701-19. |
|31.||da Silva CM, Cruz F. Has botulinum toxin therapy come of age: What do we know, what do we need to know, and should we use it? Curr Opin Urol 2009;19:347-52. |
|32.||Schurch B, Hauri D, Rodic B, Curt A, Meyer M, Rossier AB. Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: A prospective study in 24 spinal cord injury patients. J Urol 1996;155:1023-9. |
|33.||Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 1988;139:919-22. |
|34.||Schurch B, Schmid DM, Stöhrer M. Treatment of neurogenic incontinence with botulinum toxin A. N Engl J Med 2000;342:665. |
|35.||Reitz A, Stöhrer M, Kramer G, Del Popolo G, Chartier-Kastler E, Pannek J, et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 2004;45:510-5. |
|36.||Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 1988;140:1331-9. |
|37.||Hohenfellner M, Humke J, Hampel C, Dahms S, Matzel K, Roth S, et al. Chronic sacral neuromodulation for treatment of neurogenic bladder dysfunction: Long-term results with unilateral implants. Urology 2001;58:887-92. |
|38.||Bosch JL, Groen J. Sacral (S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: Results of chronic electrical stimulation using an implantable neural prosthesis. J Urol 1995;154:504-7. |
|39.||Dijkema HE, Weil EH, Mijs PT, Janknegt RA. Neuromodulation of sacral nerves for incontinence and voiding dysfunctions. Clinical results and complications. Eur Urol 1993;24:72-6. |
|40.||Shaker HS, Hassouna M. Sacral nerve root neuromodulation: An effective treatment for refractory urge incontinence. J Urol 1998;159:1516-9. |
|41.||Elabbady AA, Hassouna MM, Elhilali MM. Neural stimulation for chronic voiding dysfunctions. J Urol 1994;152:2076-80. |
|42.||Koldewijn EL, van Kerrebroeck PE, Meuleman EJ, Bemelmans B, Debruyne FM. Neuromodulation effective in voiding dysfunction despite high percentage of reoperations. Eur Urol 1999; 35 Suppl 2: 15. |
|43.||Scott FB, Bradley WE, Timm GW. Treatment of urinary incontinence by implantable prosthetic sphincter. Urology 1973;1:252-9. |
|44.||Hussain M, Greenwell TJ, Venn SN, Mundy AR. The current role of the artificial urinary sphincter for the treatment of urinary incontinence. J Urol 2005;174:418-24. |
|45.||Reynard J, Mark S, Turner K, Armenakas N, Feneley M, Sullivan M. Urological surgery. Oxford Specialist Handbooks in Surgery. Oxford University Press, Oxford UK. 2008. p. 724-40. |
|46.||Murray KH, Nurse DE, Mundy AR. Detrusor behaviour following implantation of the Brantley Scott artificial urinary sphincter for neuropathic incontinence. Br J Urol 1988;61:122-8. |
|47.||Chartier Kastler E, Genevois S, Gamé X, Denys P, Richard F, Leriche A, et al. Treatment of neurogenic male urinary incontinence related to intrinsic sphincter insufficiency with an artificial urinary sphincter: A French retrospective multicentre study. BJU Int 2011;107:426-32. |
|48.||Singh G, Thomas DG. Artificial urinary sphincter in patients with neurogenic bladder dysfunction. Br J Urol 1996;77:252-5. |
|49.||Light JK, Pietro T. Alteration in detrusor behavior and the effect on renal function following insertion of the artificial urinary sphincter. J Urol 1986;136:632-5. |
|50.||Patki P, Hamid R, Shah PJ, Craggs M. Long-term efficacy of AMS 800 artificial urinary sphincter in male patients with urodynamic stress incontinence due to spinal cord lesion. Spinal Cord 2006;44:297-300. |
|51.||Venn SN, Greenwell TJ, Mundy AR. The long-term outcome of artificial urinary sphincters. J Urol 2000;164:702-6. |
|52.||Bersch U, Göcking K, Pannek J. The artificial urinary sphincter in patients with spinal cord lesion: Description of a modified technique and clinical results. Eur Urol 2009;55:687-93. |
|53.||Lemelle JL, Guillemin F, Aubert D, Guys JM, Lottmann H, Lortat-Jacob S, et al. A multicenter evaluation of urinary incontinence management and outcome in spina bifida. J Urol 2006;175:208-12. |
|54.||Khoury AE, Dave S, Peralta-Del Valle MH, Braga LH, Lorenzo AJ, Bägli D. Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder. BJU Int 2008;101:223-6. |
|55.||González R, Merino FG, Vaughn M. Long-term results of the artificial urinary sphincter in male patients with neurogenic bladder. J Urol 1995;154:769-70. |
|56.||Cher ML, Allen TD. Continence in the myelodysplastic patient following enterocystoplasty. J Urol 1993;149:1103-6. |
|57.||Medel R, Ruarte AC, Herrera M, Castera R, Podesta ML. Urinary continence outcome after augmentation ileocystoplasty as a single surgical procedure in patients with myelodysplasia. J Urol 2002;168:1849-52. |
|58.||Kreder KJ, Webster GD. Management of the bladder outlet in patients requiring enterocystoplasty. J Urol 1992;147:38-41. |
|59.||Shpall AI, Ginsberg DA. Bladder neck closure with lower urinary tract reconstruction: Technique and long-term followup. J Urol 2004;172:2296-9. |
|60.||Eckford SB, Kohler-Ockmore J, Feneley RC. Long-term follow-up of transvaginal urethral closure and suprapubic cystostomy for urinary incontinence in women with multiple sclerosis. Br J Urol 1994;74:319-21. |
|61.||Nomura S, Ishido T, Teranishi J, Makiyama K. Long-term analysis of suprapubic cystostomy drainage in patients with neurogenic bladder. Urol Int 2000;65:185-9. |
|62.||Colli J, Lloyd LK. Bladder neck closure and suprapubic catheter placement as definitive management of neurogenic bladder. J Spinal Cord Med 2011;34:273-7. |
|63.||Smith GI, Hinman F Jr. The intussuscepted ileal cystostomy. J Urol 1955;73:261-9. |
|64.||Schwartz SL, Kennelly MJ, McGuire EJ, Faerber GJ. Incontinent ileo-vesicostomy urinary diversion in the treatment of lower urinary tract dysfunction. J Urol 1994;152:99-102. |
|65.||Leng WW, Faerber G, Del Terzo M, McGuire EJ. Long-term outcome of incontinent ileovesicostomy management of severe lower urinary tract dysfunction. J Urol 1999;161:1803-6. |
|66.||Gauthier AR Jr, Winters JC. Incontinent ileovesicostomy in the management of neurogenic bladder dysfunction. Neurourol Urodyn 2003;22:142-6. |
|67.||Gudziak MR, Tiguert R, Puri K, Gheiler EL, Triest JA. Management of neurogenic bladder dysfunction with incontinent ileovesicostomy. Urology 1999;54:1008-11. |
|68.||Rivas DA, Karasick S, Chancellor MB. Cutaneous ileocystostomy (a bladder chimney) for the treatment of severe neurogenic vesical dysfunction. Paraplegia 1995;33:530-5. |
|69.||Hellenthal NJ, Short SS, O′Connor RC, Eandi JA, Yap SA, Stone AR. Incontinent ileovesicostomy: Long-term outcomes and complications. Neurourol Urodyn 2009;28:483-6. |
|70.||Tan HJ, Stoffel J, Daignault S, McGuire EJ, Latini JM. Ileovesicostomy for adults with neurogenic bladders: Complications and potential risk factors for adverse outcomes. Neurourol Urodyn 2008;27:238-43. |
|71.||Bricker EM. Functional results of small intestinal segments as bladder substitutes following pelvic evisceration; a progress report. Surgery 1952;32:372-83. |
|72.||Pitts WR Jr, Muecke EC. A 20-year experience with ileal conduits: The fate of the kidneys. J Urol 1979;122:154-7. |
|73.||Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I. Long-term complications of conduit urinary diversion. J Urol 2011;185:562-7. |
|74.||Moeller BA. Some observations of 31 spinal cord injury patients on whom the Bricker procedure was performed. Paraplegia 1977;15:230-7. |
|75.||Comarr AE. Renal complications of the ileal conduit and cutaneous vesicostomy among patients with traumatic cord bladders. J Urol 1972;107:762-5. |
|76.||Koziol I, Hackler RH. Cutaneous ureteroileostomy in the spinal cord injured patient: A 15-year experience. J Urol 1975;114:709-11. |
|77.||Kambouris AA, Allaben RD, Carpenter WS, Shumaker EJ. Ileal loop ureteroileostomy in patients with neurogenic bladder. Personal experience with 54 patients. Am J Surg 1976;131:224-7. |
|78.||Chartier-Kastler EJ, Mozer P, Denys P, Bitker MO, Haertig A, Richard F. Neurogenic bladder management and cutaneous non-continent ileal conduit. Spinal Cord 2002;40:443-8. |
|79.||Singh G, Wilkinson JM, Thomas DG. Supravesical diversion for incontinence: A long-term follow-up. Br J Urol 1997;79:348-53. |
|80.||Kato H, Hosaka K, Kobayashi S, Igawa Y, Nishizawa O. Fate of tetraplegic patients managed by ileal conduit for urinary control: Long-term follow-up. Int J Urol 2002;9:253-6. |
|81.||Koch MO, McDougal WS, Hall MC, Hill DE, Braren HV, Donofrio MN. Long-term metabolic effects of urinary diversion: A comparison of myelomeningocele patients managed by clean intermittent catheterization and urinary diversion. J Urol 1992;147:1343-7. |
|82.||Sekar P, Wallace DD, Waites KB, DeVivo MJ, Lloyd LK, Stover SL, et al. Comparison of long-term renal function after spinal cord injury using different urinary management methods. Arch Phys Med Rehabil 1997;78:992-7. |
|83.||Cartwright PC, Snow BW. Bladder auto-augmentation: Early clinical experience. J Urol 1989;142:505-8. |
|84.||Kennelly MJ, Gormley EA, McGuire EJ. Early clinical experience with adult bladder auto-augmentation. J Urol 1994;152:303-6. |
|85.||Stöhrer M, Kramer A, Goepel M, Löchner-Ernst D, Kruse D, Rübben H. Bladder auto-augmentation - An alternative for enterocystoplasty: Preliminary results. Neurourol Urodyn 1995;14:11-23. |
|86.||Stöhrer M, Kramer G, Goepel M, Löchner-Ernst D, Kruse D, Rübben H. Bladder autoaugmentation in adult patients with neurogenic voiding dysfunction. Spinal Cord 1997;35:456-62. |
|87.||Leng WW, Blalock HJ, Fredriksson WH, English SF, McGuire EJ. Enterocystoplasty or detrusor myectomy? Comparison of indications and outcomes for bladder augmentation. J Urol 1999;161:758-63. |
|88.||Stohrer M, Kramer G, Goepel M. Bladder auto-augmentation in adult neurogenic bladder: Long term follow-up. J Urol 2000;163:224A. |
|89.||McDougall EM, Clayman RV, Figenshau RS, Pearle MS. Laparoscopic retropubic auto-augmentation of the bladder. J Urol 1995;153:123-6. |
|90.||Adams MC, Joseph DB. Urinary tract reconstruction in children. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 10 th ed., Vol. 4. Philadelphia: Elsevier; 2012. p. 3489. |
|91.||Nguyen DH, Mitchell ME, Horowitz M, Bagli DJ, Carr MC. Demucosalized augmentation gastrocystoplasty with bladder autoaugmentation in pediatric patients. J Urol 1996;156:206-9. |
|92.||Karsenty G, Vidal F, Ruffion A, Chartier-Kastler E. Treatment of neurogenic detrusor hyperactivity: Detrusor myomectomy. Prog Urol 2007;17:580-3. |
|93.||von Mikulicz J. Zur operation der angebarenen bla ß en-Spalte. Zentralbl Chir 1889;20:641-3. |
|94.||Bramble FJ. The treatment of adult enuresis and urge incontinence by enterocystoplasty. Br J Urol 1982;54:693-6. |
|95.||Docimo SG, Moore RG, Adams J, Kavoussi LR. Laparoscopic bladder augmentation using stomach. Urology 1995;46:565-9. |
|96.||Gill IS, Rackley RR, Meraney AM, Marcello PW, Sung GT. Laparoscopic enterocystoplasty. Urology 2000;55:178-81. |
|97.||Rackley RR, Abdelmalak JB. Laparoscopic augmentation cystoplasty. Surgical technique. Urol Clin North Am 2001;28:663-70. |
|98.||Kang IS, Lee JW, Seo IY. Robot-assisted laparoscopic augmentation ileocystoplasty: A case report. Int Neurourol J 2010;14:61-4. |
|99.||Linder A, Leach GE, Raz S. Augmentation cystoplasty in the treatment of neurogenic bladder dysfunction. J Urol 1983;129:491-3. |
|100.||Gurung PM, Attar KH, Abdul-Rahman A, Morris T, Hamid R, Shah PJ. Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: A minimum of 10 years of follow-up. BJU Int 2012;109:1236-42. |
|101.||Quek ML, Ginsberg DA. Long-term urodynamics followup of bladder augmentation for neurogenic bladder. J Urol 2003;169:195-8. |
|102.||Mast P, Hoebeke P, Wyndaele JJ, Oosterlinck W, Everaert K. Experience with augmentation cystoplasty: A review. Paraplegia 1995;33:560-4. |
|103.||Herschorn S, Hewitt RJ. Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder. Urology 1998;52:672-8. |
|104.||Andrew MR, Lloyd K. Long term outcomes of augmentation cystoplasty in spinal cord injured patients. J Urol 2000;163:52. |
|105.||Chartier-Kastler EJ, Mongiat-Artus P, Bitker MO, Chancellor MB, Richard F, Denys P. Long-term results of augmentation cystoplasty in spinal cord injury patients. Spinal Cord 2000;38:490-4. |
|106.||Gobeaux N, Yates DR, Denys P, Even-Schneider A, Richard F, Chartier-Kastler E. Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: Long-term functional results. Neurourol Urodyn 2012;31:672-6. |
|107.||Robertson AS, Davies JB, Webb RJ, Neal DE. Bladder augmentation and replacement. Urodynamic and clinical review of 25 patients. Br J Urol 1991;68:590-7. |
|108.||Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB. Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet 2006;367:1241-6 |
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