Augmentation cystoplasty after spinal cord injury: durable at 19 years, with stones and cancer to watch for

Design

Single-centre retrospective cohort

Population

70 people with spinal cord injury and refractory neurogenic bladder, mean follow-up 19 years

Primary outcome

Urodynamic, continence and complication outcomes

Effect

Capacity 155 to 490 mL; pressure 72 to 19 cmH₂O; 67% continent; adenocarcinoma 4%

A tertiary centre reviewed 70 people with spinal cord injury and refractory neurogenic bladder dysfunction who had augmentation cystoplasty between 1988 and 2018, with a mean follow-up of 19 years.

Bladder capacity rose from a mean of 155 to 490 mL and maximum detrusor pressure fell from 72 to 19 cmH₂O. Two-thirds were fully continent and a further 24% had only occasional leakage. Recurrent infections and antimuscarinic use fell, and reflux improved in most. Late complications included stones in 10%, adenocarcinoma in 4% and spontaneous perforation in 1.5%. Eighteen patients needed adjunctive intradetrusor botulinum toxin, with further improvement in selected measures.

This is a single-centre retrospective series, and those who were lost or died may have fared differently.

The operation still has a place where less invasive options have failed, provided patients understand that surveillance is lifelong.

• Consider augmentation cystoplasty for refractory neurogenic bladder after spinal cord injury when less invasive options fail.
• Counsel about a lifelong risk of stones, perforation and adenocarcinoma in the augmented bladder.
• Arrange structured lifelong surveillance after augmentation.
• Consider intradetrusor botulinum toxin if pressures rise again after augmentation.

Why it matters

Long follow-up is what patients considering a major reconstruction need, and it is rarely available.

The statistics, in plain English

A 4% cancer rate over 19 years in 70 patients is about three people, so the estimate is imprecise, but it confirms a real long-term risk.

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