Augmentation cystoplasty after spinal cord injury: durable gains, but lifelong surveillance is needed

Design

Retrospective single-centre cohort, 1988 to 2018, mean follow-up 19 years

Population

70 patients with spinal cord injury and refractory neurogenic lower urinary tract dysfunction

Primary outcome

Urodynamic capacity and pressure, continence, infections and complications

Effect

Capacity 155 to 490 mL; detrusor pressure 72 to 19 cmH2O; continence 67%; stones 10%, malignancy 4%

A tertiary-centre retrospective cohort followed 70 patients with spinal cord injury and refractory neurogenic lower urinary tract dysfunction who had augmentation cystoplasty between 1988 and 2018, for a mean of 19 years (range 5 to 36).

Maximum cystometric capacity rose from 155 to 490 mL and maximum detrusor pressure fell from 72 to 19 cmH2O (both P < 0.001). Continence was achieved in 67%, with 24% having only occasional leakage. Recurrent urinary infections and antimuscarinic use fell, and reflux improved in most affected patients. Late complications included urolithiasis in 10%, malignancy in 4% (all adenocarcinoma) and spontaneous perforation in 1.5%. Among 18 patients given adjunctive intradetrusor onabotulinumtoxinA, improvements in capacity and pressure were significant in selected analyses.

This is a single-centre series with no comparison group, spanning three decades of changing practice. It supports offering augmentation to carefully selected patients who have failed less invasive treatment, with an explicit plan for lifelong follow-up.

• Capacity rose from 155 to 490 mL and detrusor pressure fell from 72 to 19 cmH2O.
• 67% were continent and a further 24% had only occasional leakage.
• Stones affected 10%, malignancy 4% and spontaneous perforation 1.5%.
• Follow-up averaged 19 years in 70 patients at one centre.
• Arrange lifelong surveillance, including cystoscopy and upper tract review, when offering augmentation.

Why it matters

Long-term outcome and complication data help decide who should be offered a major reconstructive operation, and what follow-up it commits them to.

Don't overread it

A single-centre retrospective series with no comparison group cannot show that augmentation is better than alternatives.

The statistics, in plain English

The before-and-after comparison uses the same patients, so it shows change but not what would have happened without surgery. The 4% malignancy rate comes from a small group over many years and should be seen as a range rather than a precise risk.

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