Korean J Urol.  2013 Jan;54(1):42-47.

Is Concomitant Bladder Neck Reconstruction Necessary in Neurogenic Incontinent Patients Who Undergo Augmentation Cystoplasty?

• Lee HE
• Bae J
• Oh JK
• Oh SJ

Abstract

PURPOSE
In patients with neurogenic bladder due to spinal cord injury or disease who undergo augmentation cystoplasty (AC) for not only bladder dysfunction but also sphincteric incontinence, the need for concomitant bladder neck reconstruction at the time of AC has not yet been established. The aim of this study was to evaluate whether concomitant bladder neck reconstruction is necessary when performing AC.
MATERIALS AND METHODS
We retrospectively investigated 35 patients who underwent AC from January 2006 to September 2010. Medical history, preoperative and postoperative fluoroscopic urodynamic study (FUDS) parameters, and responses to an incontinence questionnaire (ICIQ Korean version) were reviewed.
RESULTS
A final analysis was performed on 17 patients (9 male, 8 female) who were diagnosed with sphincteric incontinence. Continence status, the number of pads used, and the bother score were significantly improved postoperatively in this subpopulation. Preoperatively, all patients used pads, and the average daily number was 2.2 (median; range 0 to 6). Postoperatively, the number of pads used decreased significantly to 0.9 (median; range 0 to 3) pads a day (p=0.002). Urodynamic parameters including bladder capacity, compliance, involuntary detrusor contraction, and bladder neck incompetence proven by FUDS were also significantly improved.
CONCLUSIONS
Our study demonstrated that both objective urodynamic parameters and subjective incontinence symptoms improved significantly after the completion of AC as a single procedure in patients with sphincteric incompetence. This implies that anti-incontinence bladder outlet surgery does not have to be performed simultaneously and can be considered later as a staged operation.

Keyword

Neurogenic dysfunction of the urinary bladder; Neurogenic urinary bladder; Urinary incontinence; Urodynamics

MeSH Terms

Compliance
Contracts
Humans
Male
Neck
Retrospective Studies
Spinal Cord Injuries
Urinary Bladder
Urinary Bladder, Neurogenic
Urinary Incontinence
Urodynamics

Figure

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  FIG. 1 A 64 year-old male with spinal cord injury showed improvement of bladder compliance and bladder neck competence. His preoperative International Consultation on Incontinence Modular Questionnaire score was 16, and postoperative score was 1. Preoperatively, this patient showed an incompetent bladder neck (A) and poor bladder compliance (C). Six months postoperatively, this patient showed a competent bladder neck (B) and improved bladder compliance (D).

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