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Bladder Augmentation: is there an Indication for Mini-invasive Surgical Approach?

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Functional Urologic Surgery in Neurogenic and Oncologic Diseases

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

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Abstract

Augmentation cystoplasty (AC) is a surgical procedure that involves the use of bowel segments to increase bladder capacity. AC can be considered as the last option in neurogenic and non-neurogenic bladder dysfunction in those cases where conservative management and minimally invasive treatments have been unsuccessful and exhausted [1, 2]. Neurological patients with neurogenic detrusor overactivity (NDO) should initially undergo medical treatment with antimuscarinics and the addition of intermittent catheterization (IC), usually needed in patients with detrusor-sphincter dyssynergia. If these are unsuccessful, the next step should be intradetrusor injections of botulinum toxin A (BoNT/A) that offer an alternative in those with intractable NDO, even though the effect is only temporary and up to a median period of 9 months. In non-neurological patients, when antimuscarinics fail, BoNT/A, at the lower dosage of 100 U, is indicated, even if there is still a relative risk of urinary retention and consequent catheterization, not always accepted by patients suffering from idiopathic conditions [3, 4]. Alternatively, in non-neurogenic patients with symptoms refractory to other treatments, the neuromodulation may also be attempted [5]; this approach offers a quality-of-life (QoL) improvement comparable with antimuscarinics [6]. Patients who fail treatment with all these modalities are then considered for AC that is the most common indication in neurogenic patients.

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Authors and Affiliations

  1. Neurourology Unit, University Careggi Hospital, Florence, Italy

    Giulio Del Popolo

  2. Pediatric Urology, Bambino Gesù Hospital, Rome, Italy

    Giovanni Mosiello

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  1. Giulio Del Popolo
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  2. Giovanni Mosiello
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Correspondence to Giulio Del Popolo .

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Editors and Affiliations

  1. Dept Medico-Surgical Sci&Biotechnologies, Sapienza University of Rome, Rome, Italy

    Antonio Carbone

  2. Dept Medico-Surgical Sci&Biotechnologies, Sapienza University of Rome, Rome, Italy

    Giovanni Palleschi

  3. Dept Medico-Surgical Sci&Biotechnologies, Sapienza University of Rome, Rome, Italy

    Antonio Luigi Pastore

  4. Urologic Surgery, Max Fourestier Hospital, Nanterre, France

    Aurel Messas

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Del Popolo, G., Mosiello, G. (2016). Bladder Augmentation: is there an Indication for Mini-invasive Surgical Approach?. In: Carbone, A., Palleschi, G., Pastore, A., Messas, A. (eds) Functional Urologic Surgery in Neurogenic and Oncologic Diseases. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-29191-8_14

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