Lima SV et al. (2008) Nonsecretory intestinocystoplasty: a 15-year prospective study of 183 patients. J Urol 179: 1113–1117

Use of bowel segments for bladder augmentation has recognized long-term complications—perforation, stone formation, electrolyte disturbances and cancer—attributed to the presence of secretory mucosa in the augmented bladder. Lima and colleagues, therefore, use de-epithelialized bowel segments for bladder augmentations; they now report 15 years of their experience with this technique.

Bladder augmentation was performed in 183 patients (age range 3 months–53 years, 92 males). Indications for surgery included neurogenic bladder (n = 121) and bladder exstrophy (n = 50). In the first 24 patients, separated bladder urothelium was used as a 'natural mold' to line the de-epithelialized bowel segment, and kept distended with urine for 2 weeks postsurgery. In subsequent patients, a silicone mold was used, which was removed after 10 days. No electrolyte disturbance, mucus formation, or malignancy occurred during follow-up (mean 75.9 months, range 2–189 months). Treatment significantly improved both bladder capacity and compliance (P ≤0.001).

Treatment failed in 23 patients (12.6%), in 5 cases during the early postoperative period. The overall complication rate was 6.6%. Two perforations occurred, 2 years and 5 years after surgery. Both perforations were located at the transition between native bladder and bowel, and occurred in patients who underwent the silicone-mold procedure. Seven bladder stones occurred in patients treated for exstrophy, but were attributed to the additional bladder-neck procedures these patients had undergone at augmentation.

Although these failure and complication rates can be improved on, Lima and colleagues suggest that their approach has substantial advantages over traditional augmentation procedures.