Archivos españoles de urología (Impact Factor: 0.31). 01/2011; 64(10):953-959.


The purpose of bladder augmentation using the gastrointestinal tract is to create a low-pressure and high-capacity reservoir, permitting suitable continence and voiding, preserving the upper urinary tract.OBJECTIVE: To analyze the indications, complications and results of our series of augmentation enterocystoplasties. METHOD: We retrospectively reviewed patients undergoing augmentation enterocystoplasty in our department between 1997 and 2010, both included. The indications were: Interstitial cystitis, neurogenic bladder and inflammatory bladder retraction. In all cases a cystography, urethrocystoscopy, urodynamic study and voiding diary were performed, as well as the specific studies of each condition. Bladder release is performed by means of medial laparotomy and an extraperitoneal approach with bivalve opening to the urethral orifices. The bladder augmentation is performed with a 15-20 cm segment of detubularized ileum obtained at 20 cm from the ileocecal valve; in cases of kidney failure, a 7-cm gastric body wedge is added. The bladder catheter was removed following cystogram after 15 days. Monitoring was performed by means of ultrasound with postvoid residual, blood analyses, urine culture and voiding diary. We performed a descriptive study of the demographic characteristics, postoperative complications according to the Clavien classification and in the long term. RESULTS: We included 24 patients, 19 women and 5 men with a mean age of 48.5 years and a median of 47 (21-77). Mean follow up was 7.5 years with a median of 8 (1-11). The indications were: 7 interstitial cystitis, 8 bladder retraction and 7 neurogenic bladder. There were no intraoperative complications. The postoperative complications were 3 Clavien I, 2 type II, 2 IIIA and 1 IIIB. In the long term, 3 patients presented urinary incontinence, 2 mild metabolic acidosis, 5 required self-catheterization, 6 bladder stones, 2 febrile urinary tract infections and 1 stricture of the anastomotic mouth. In three cases, an ileogastrocystoplasty was performed without hydroelectrolytic impairment or impairment of kidney function. CONCLUSIONS: In selected patients, augmentation enterocystoplasty constitutes an efficacious therapeutic option in the treatment of lower urinary tract dysfunction with scant morbidity and few complications.

52 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ionized ammonia (NH3) transport in the intestine has not been previously established as a mechanism of acidosis in urinary intestinal diversion or hepatic failure. The purpose of this study was to establish that ionized transport of ammonium (NH4) occurs in the intestine and to characterize the mechanism of its transport using the methodology of brush border membrane vesicles and acridine orange fluorescence. An NH4/H exchange was demonstrated and found to be the dominant mechanism causing a pH change when NH4 is transported across the lumenal membrane. Ionized NH4 transport was demonstrated to occur against an NH3 concentration gradient. The Km was 1.02 mmol and the Vmax was 247 U/sec. The Hill coefficient was 0.97, indicating a single port. Ammonium hydrogen exchange could be inhibited by amiloride but not by bumetanide. Sodium, potassium or chloride, or both, did not effect the NH4/H exchanger. This study establishes that ionized NH4 transport occurs across the small intestine brush border in exchange for a hydrogen ion.
    Journal of the American College of Surgeons 10/1995; 181(3):241-8. · 5.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the role of local immune response against bacterial invasion of the urinary tract we studied 168 patients with bacteriuria. Urinary secretory immunoglobulins A (sIgA) were measured using radial immunodiffusion or enzyme-linked immunosorbent assay (ELISA). In particular, ELISA is a very suitable assay for measuring the low levels of sIgA in urine. Furthermore, we used a quantitative in vitro adherence assay to investigate the attachment of Escherichia coli to human uroepithelial cells after incubation in urine from patients with urinary tract infection. Urine from patients with ileocystoplasty was significantly more potent in inhibiting bacterial adherence than was urine from other groups of patients with urinary tract infection. The presence of high urinary sIgA may help explain the increased antiadherence activity of urine in patients with ileocystoplasty. Mean urinary sIgA in patients with upper urinary tract infection was higher than in patients with uncomplicated infection in the lower urinary tract. Alterations in mucosal immune functions may account for the propensity toward bacterial colonization in women prone to uncomplicated urinary tract infection.
    Urological Research 02/1990; 18(5):305-8. DOI:10.1007/BF00300776 · 1.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the aetiology of stones which occur in enterocystoplasties and continent diversions, generally attributed to the presence of foreign material, e.g. staples, or to recurrent urinary infection, in patients with augmented or substituted bladders. The study comprised 467 patients who had undergone reconstruction of the lower urinary tract and had been followed up for at least 3 years using videourodynamics and ultrasonography. Stones were found in 42 patients (9%); 50% were found incidentally and the remaining patients presented with symptomatic infections (27%) or deterioration in urinary continence (23%). Stones occurred in 6% of patients with augmentation, in 7% of those with substitution cystoplasty and in 22% of patients with continent diversions. Most patients with stones (88%) used clean intermittent self-catheterization (CISC). Stones were 5-10 times commoner in patients using CISC than in patients voiding spontaneously. Urinary stasis was a more important cause of stone formation than was bacteriuria in patients with cystoplasty. The presence of mucus and bacteriuria are presumed to be contributory. To reduce the risk of stone formation, orthotopic cystoplasty and spontaneous voiding are to be preferred to continent diversion and CISC. Periodic bladder washouts may be an alternative solution.
    British Journal of Urology 06/1996; 77(5):684-7. DOI:10.1046/j.1464-410X.1996.97311.x
Show more