Fecal and urinary continence after ileal cecal cystoplasty for the neurogenic bladder.

Abstract

In patients with a neurogenic bladder augmentation with the ileal cecal segment has generally been disregarded as an option due to concerns regarding fecal incontinence. We report our results using a hemi-Indiana pouch bladder augmentation for neurogenic bladder. A review of 63 patients with neurogenic bladder dysfunction treated with a hemi-Indiana pouch bladder augmentation was performed. None of the patients had fecal incontinence before surgery. Median followup interval was 6 years (range 1 to 10). Etiology of the neurogenic bladder was spinal cord injury in 42 patients (66%), myelodysplasia in 18 (29%) and sacral agenesis in 3 (5%). One patient (1.5%) died immediately postoperatively from a pulmonary embolus. Of the remaining 62 patients, urinary continence was achieved in 54 (87%) and 8 were incontinent per the abdominal stoma. All 8 patients were treated with Contigen injections into the stoma and 4 (50%) became continent. The 4 patients with persistent urinary incontinence became continent after open surgical revision. Postoperatively, fecal continence was improved in 14 patients (23%), unchanged in 46 (74%) and worse in 2 (3%). In 2 patients with deterioration in bowel function stool frequency and fecal soilage increased in conjunction with antibiotic usage. No patient had chronic fecal incontinence. In select patients with neurogenic bladder dysfunction ileal cecal bladder augmentation with a continent tapered ileal limb results in a 100% incidence of urinary continence with minimal alterations in fecal continence.