Female Pelvic Surgery

12. Augmentation Cystoplasty

Geneviève Nadeau  and Sender Herschorn 


Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada


Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

Geneviève Nadeau

Email: Genevieve.nadeau.6@ulaval.ca

Sender Herschorn (Corresponding author)

Email: s.herschorn@utoronto.ca


Augmentation cystoplasty (AC) is a surgical procedure used to increase bladder storage capacity or improve detrusor compliance. Performed by urologists for more than a century, the technique has evolved over the years, using different segments of the gastrointestinal (GI) tract. It is frequently combined with other procedures depending on the need for correction of associated problems (bladder outlet correction, ureteral obstruction, etc.), and more recently has been performed laparoscopically or robotically. Even though its role has declined over the years, decreasing from 192 operations in 2000 in the United Kingdom to 120 in 2010 [1], it remains of paramount importance for the reconstructive urologist to be proficient with this procedure. This chapter will outline the indications and technique of bladder augmentation as well as focus on the short- and long-term complications.


First described in dogs in 1888 by Tizzoni and Foggi [2] and in 1899 in humans by von Mikulicz [3], augmentation cystoplasty was reported by Couvelaire in 1950 to treat tuberculosis cystitis [4]. The use of different segments of the GI tract has been described: colon in 1912 by Charghi [5], sigmoid by Bisgard in 1943 [6], cecum by Couvelaire [4], stomach in 1956 by Sinaiko [7], and finally the classic detubularized ileal patch by Goodwin in 1959 [8]. A wide variety of other organic tissues (peritoneum, omentum, gallbladder, skin, etc.) have also been unsuccessfully attempted and abandoned [9]. Finally, the introduction of clean intermittent catheterization (CIC) by Lapides in 1972 allowed the procedure to gain widespread acceptance [10].


Considering that AC is an invasive procedure, it should be offered only after more conservative interventions such as behavioral modification, anticholinergics, botulinum toxin (BTX-A), or sacral neuromodulation have been considered and failed, as recommended by the 4th International Consultation on Incontinence [11]. Many conditions may necessitate AC (Table 12.1), whether in the setting of upper tract deterioration due to high bladder storage pressures (detrusor leak point pressure over 40 cm H2O) or unacceptable incontinence secondary to contracted bladder volume and decreased compliance or overactivity [12].

Table 12.1

Indications for augmentation cystoplasty





Tethered spinal cord

Exstrophy (classic, cloacal, epispadias)

Sacral agenesis

Caudal regression

Posterior urethral valves

Acquired neurogenic

Spinal cord injury

Spinal tumors


Multiple sclerosis


Acquired non-neurogenic

Detrusor overactivity

Defunctionalized bladder in patients on dialysis





Interstitial cystitis

Radiation cystitis

Chemotherapy-induced cystitis


Intraoperative loss of bladder wall (after extirpative surgery for malignancy)

Urinary undiversion

Neurogenic conditions caused by congenital, acquired, or traumatic etiologies, especially myelodysplasia in children and spinal cord injuries in adults, are probably the most frequent indications. Although there is considerable variation in institutional rates, it has been estimated that 5–30 % of patients with spina bifida will undergo AC [1314]. Multiple sclerosis, with its inherent progressive neuromuscular deterioration that may make intermittent self-catheterization difficult [15], is preferably managed with medical therapy such as anticholinergics and botulinum toxin but occasional cases may be amenable to AC.

Patients with severe refractory idiopathic overactive bladder (OAB) or rarely interstitial cystitis can also be offered such a procedure, but this should be a last resort option for carefully selected cases, as pointed out by the American Urological Association guidelines [1617].

Benign diseases with decrease in compliance from collagen deposition in the bladder wall are other indications. Tuberculosis cystitis, which used to be the number one indication in the past, is now a rarity [15]. Schistosomiasis, an endemic parasitic infection found primarily in the Middle East and Africa, may cause bladder wall fibrosis in 2 % of cases [1]. Reduced bladder capacity may be improved by AC.

Pelvic radiation therapy or surgical resection for colorectal, gynecological, or urological malignancies may also compromise the urinary tract and necessitate AC.

Finally, a defunctionalized bladder in a patient on dialysis awaiting renal transplantation might warrant AC to restore proper lower urinary tract function and protect the allograft, although its timing (before, after, or even concomitantly with the transplantation) is controversial [18], the concern being the risk of severe sepsis in the immunosuppressed patient [1].


Poor baseline renal function may potentially expose patients to severe electrolyte abnormalities and worsening renal function and is a relative contraindication. However, in patients with renal dysfunction that is a direct result of bladder dysfunction with elevated storage pressure, AC may be appropriate and help stabilize renal function [19]. Other relative contraindications include inflammatory bowel disease (Crohn’s disease), irradiated bowel, short gut syndrome, bladder tumors, and liver failure [20].

Preoperative Surgical Considerations

Extensive history and physical exam, serum chemistries (complete blood count, electrolyte and creatinine levels, coagulation factors), urine cytology, urinalysis, and cultures are required. All patients should also undergo anatomic and functional assessment of the urinary tract with cystoscopy (to exclude intravesical abnormalities such as tumors), urodynamics (to characterize bladder capacity, compliance, or uninhibited detrusor contractions, to assess detrusor and Valsalva leak point pressures, and to rule out infravesical obstruction), cystography (to rule out vesicoureteral reflux), and upper tract imaging (ultrasound or computerized tomography; to document the presence of hydronephrosis or stone disease). A history of bowel disease may require preoperative bowel imaging studies or colonoscopy. A voiding diary can help in planning for the final reservoir size by assessing 24-h urine volume [21], although the augmentation usually enlarges with time. The need for latex precautions for at-risk patients with spinal dysraphism should also be kept in mind. Planning for other concomitant procedures such as a continent catheterizable stoma (using the Mitrofanoff or Monti principles), ureteral reimplantation, or bladder neck management is an essential prerequisite before considering the intervention [22]. Finally, since CIC is frequently a necessary adjunct, adequate manual dexterity and cognitive abilities are prerequisites to be considered an adequate surgical candidate and it is crucial, in the preoperative visits, to reinforce the importance of compliance with CIC postoperatively [23].

Bowel Preparation and Antibiotic Coverage

Preoperative mechanical bowel preparation continues to be an issue of controversy. In the colorectal surgery literature, it does not lower the rate of postoperative complications (wound infection, intraperitoneal abscess, or anastomotic leak) [2425] and some patients have reported adverse events from it [2628]. There are two pediatric studies that have reported no increase in complications after AC following no preoperative mechanical bowel preparation [2930]. However, there are no prospective randomized trials so caution should be exercised especially in patients with ventriculoperitoneal shunts that may be exposed to fecal contamination intraoperatively [31]. Even though there is no consensus among the studies with the duration, the dosage, and the type of bowel preparation to use, we agree with the most recent CDC guidelines (published in 1999) [32] and still routinely prescribe mechanical bowel preparation and clear fluids diet the day prior to the intervention.

The periprocedural systemic administration of an antimicrobial agent to reduce infectious risks in contaminated urology surgery [33] is an evidence-based supported concept, but the literature is not clear about the optimal therapeutic regimen (type of medication, dosage, and route of administration). Available practice guidelines recommend a combination of either second- or third-generation cephalosporin with an aminoglycoside and metronidazole, with special caution for patients with prosthetic devices such as ventriculoperitoneal shunts or orthopedic hardware [3233].

Choice of Intestinal Segment

Different parts of the GI tract from stomach to sigmoid have been used for bladder augmentation, each having its pros and cons (Table 12.2), but none being the ideal segment.

Table 12.2

Advantages and disadvantages of different tissues used for augmentation cystoplasty





Produces less mucus

Lower incidence of bacteriuria

Rich blood supply

More appropriate for patients with renal insufficiency

Risk of bladder ulcers and perforation

Hematuria–dysuria syndrome

Vit B12 malabsorption



Severe electrolyte abnormalities

Risk of profound dehydration

Iron and calcium deficiencies


Mobile, small diameter, easy to handle

Well-defined, reliable blood supply

Less severe metabolic complications

Lipid malabsorption (Vit A, D, E, K)

Vit B12 deficiency (anemia)

Incidence of bowel obstruction more common than colon

Lack of bile salt reabsorption (diarrhea)

Metabolic acidosis

Sometimes short mesentery


Transverse colon safer if prior pelvic radiation

Fewer nutritional problems

Redundant in spina bifida patients

Antireflux tunnels easily made

Metabolic acidosis

Produces more mucus than ileum (increased risk of UTIs and stones)


Urothelial lined

Requires no intestinal resection

Limited availability (need for hydroureter)


Urothelial lined

Requires no intestinal resection

Technically demanding

Limited gain in capacity and compliance

Risk of perforation

Tissue engineering

Theoretically unlimited donor tissue

Still experimental

Data from Abou-Elela A. Augmentation cystoplasty: in pretransplant recipients. In: Ortiz J, Andre J, eds. Understanding the Complexities of Kidney Transplantation. Rijeka, Croatia: InTech; 2011:279–330; and Duel BP, Gonzalez R, Barthold JS. Alternative techniques for augmentation cystoplasty. J Urol. 1998;159(3):998–1005

Ileum is unquestionably the most widely used bowel segment in reconstructive urology. The versatility it provides allows the surgeon to refashion it in a multitude of different techniques that have been elaborated over the years [34]. With overall fewer complications than other bowel segments, it is mobile, easy to handle, with a constant blood supply, and available in large quantity [35]. However, ileum might not be ideally suited in situations where the mesentery is short, or for those with significant adhesions or prior small bowel resections [23]. Caution should be also exercised when considering ileocystoplasty for patients who underwent prior pelvic radiation therapy [36].

If functional or anatomic factors preclude the use of ileum, colon is often the second choice. Advantages of colocystoplasty include a thick muscular wall, large lumen, and abundant mesentery guaranteeing adequate bladder capacity and maneuverability [37], while disadvantages include more mucus production with increased risk of urinary tract infections (UTI) and stone formation [38]. More specifically, the sigmoid is sometimes redundant in patients with neurogenic bowel dysfunction which makes it an attractive alternative for this population [22]. Finally, the cecum, in conjunction with the terminal ileum, can be used as a continent catheterizable channel [39]. The ileocecal valve provides the continence mechanism, but its resection renders the patient vulnerable to diarrhea [40], which occasionally may be severe and difficult to manage. This may render the patient at risk for malabsorption and fecal incontinence [35].

Gastrocystoplasty as an alternative has been mostly reported in the pediatric literature [4142]. Despite clear advantages to the use of the stomach such as less mucus production, a lower incidence of bacteriuria, and a rich blood supply, the technique has declined in popularity due to significant limitations, mostly from debilitating hematuria–dysuria syndrome [43].

The use of jejunum results in severe metabolic disorders in 25–40 % of cases and therefore should not ordinarily be utilized [4445]. Although not formerly contraindicated, its use should be limited to those extremely rare cases where any other segment of the GI tract is not available for the augmentation, a situation we have not yet encountered.

Alternative tissues have also been described. Several series have reported satisfactory outcomes with ureterocystoplasty [384647]. This necessitates a hydroureter from a nonfunctioning renal unit and is practically rarely applicable [4748]. In autoaugmentation (or detrusor myectomy) of the bladder, the creation of a urothelial pseudodiverticulum is technically demanding and usually only provides a slight gain in capacity and compliance [49]. With such disappointing efficacy, the technique is rarely reported.

Finally, none of the bowel segments has been shown to be clearly superior to another in all circumstances so the reconstructive urologist needs to be proficient in several techniques making use of various segments in order to individualize the decision and optimize results.


With the ultimate goals of lowering urinary storage pressures, preserving renal function, maximizing continence, and hopefully maintaining volitional voiding, the clam ileocystoplasty is the most commonly reported technique.

With the patient supine or in the low lithotomy position, a midline infraumbilical incision is usually adequate to gain intraperitoneal access, but a short Pfannenstiel incision has also been described [50]. With a Foley catheter in the surgical field, the native bladder is distended. The loose areolar tissue is bluntly dissected to expose the anterior and perivesical spaces [51]. With stay sutures on either side, the bladder is bivalved in the coronal or sagittal plane [11]. A “smile” incision has also been described [52]. The bladder incision should be a broad opening to create a large anastomosis and prevent an hourglass deformity [35]. Occasionally, supratrigonal cystectomy can be done for conditions such as severe interstitial cystitis [53].

A 15–40 cm segment of ileum is then harvested approximately 20 cm proximal to the ileocecal valve on a broad well-vascularized pedicle that may be identified by transillumination. A side-to-side stapled or hand-sewn ileoileostomy reestablishes bowel continuity cephalad to the isolated segment and the mesenteric defect may be closed to prevent internal hernias, or alternatively left open if judged to be wide enough. The isolated segment is irrigated thoroughly until return is clear to prevent intraperitoneal soiling as much as possible. It is then detubularized on its antimesenteric side to prevent intraluminal pressure rises from peristaltic contractions. The segment is reconfigured into a U, S, or W shape [3654] (Figs. 12.1 and 12.2). The surgeon should make sure that the segment reach down into the pelvis without tension or twist on the mesentery. The ileal patch can then be reapproximated to the edges of the cystotomy, starting posteriorly, with one to two layers of 2-0 continuous absorbable sutures. The vesico-intestinal anastomosis is tested for watertightness and drains are inserted prior to closing the abdominal wall in a standard fashion. The goal is to create a new reservoir in as spherical a configuration as possible to maximize the surface area as per Laplace’s law.


Fig. 12.1

(ac) (a) Ileocystoplasty. A 20- to 40-cm segment of ileum at least 15 cm from the ileocecal valve is removed and opened on its antimesenteric border. Ileoileostomy reconstitutes the bowel. (b) The opened ileal segment should be reconfigured. This can be done in a U, S, or W configuration. It can be further folded as a cup patch. (c) The reconfigured ileal segment is anastomosed widely to the native bladder


Fig. 12.2

A 40 cm length of ileum is shown. The segment has been isolated from the GI tract and reconfigured. The antimesenteric border was incised and the bowel segment was detubularized into an inverted U shape. It will be anastomosed to the bladder

More recently, minimally invasive (laparoscopic and robot-assisted) approaches have become more frequently reported from a number of institutions. Depending on the surgeon’s experience and expertise, most of the suturing can be performed intra- or extracorporeally [55]. More technically demanding, these minimally invasive techniques have the advantages of reduced perioperative pain and morbidity, shorter hospital stay, and cosmetic superiority, with outcomes similar to the open surgery [205658].

Postoperative Care

As for any major abdominal surgery, intravenous fluids and bowel rest are maintained for several days with close monitoring of inputs and outputs. Routine nasogastric tube drainage is not required as it has not been shown to lead to faster bowel function recovery [59]. Antibiotic prophylaxis for 24 h [60], thromboprophylaxis, and early ambulation are also recommended. A closed-suction pelvic drain is kept until output tapers off or once peritoneal fluid is confirmed with fluid chemistries [21].

Proper drainage and irrigation of the augment, initially several times a day with 50–100 mL of sterile saline and then gradually reduced to an as-needed basis, are necessary to prevent mucus from accumulating, plugging the catheters and disrupting the fresh anastomosis. We usually favor a Foley urethral catheter (16–18 Fr) and a suprapubic (SP) Malecot catheter (20–22 Fr). Both tubes are kept for approximately 4 weeks, after which a cystogram is performed. The Foley is then removed if there is no extravasation and patients resume spontaneous voiding. Post-void residuals are closely monitored initially as well as on a long-term basis, and CIC is initiated when needed. The SP tube may be kept for 1–2 more weeks longer and used for daily bladder irrigation. Although there is no evidence to support it, antimicrobial prophylaxis can be administered at the time of catheter removal since bacterial colonization has likely occurred [33].


Flood and colleagues reported an overall 28 % early and 44 % late complication rate in this difficult group of patients, with a chance of requiring a reintervention ranging from 15 % to 40 % [6163]. Table 12.3 lists the possible consequences of such procedure.

Table 12.3

Complications of augmentation cystoplasty




Wound infection

Intraperitoneal abscess


Ventriculoperitoneal shunt sepsis

Metabolic disturbances

Metabolic acidosis




Hyperammonemia (encephalopathy)

Wound dehiscence

Mucus accumulation

Prolonged ileus


Peroneal nerve palsy


Anastomotic leak



Bowel dysfunction


Fecal incontinence

Bowel obstruction




Bladder perforation


Upper tract deterioration/Renal dysfunction



Vitamins A, D, E, K deficiencies

Bile salts (gallbladder stones)

Vitamin B12 deficiency (megaloblastic anemia)


Hematuria–dysuria syndrome (gastric)


Drug absorption toxicities


Bone demineralization/Impaired growth


Urinary retention/Diverticularization



Data from Herschorn S WB. Bladder augmentation. In: HB G, ed. Complications of female incontinence and pelvic reconstructive surgery. Cleveland, OH: Humana Press; 2013:171–187; Flood HD, Malhotra SJ, O’Connell HE, Ritchey MJ, Bloom DA, McGuire EJ. Long-term results and complications using augmentation cystoplasty in reconstructive urology. Neurourol Urodyn. 1995;14(4):297–309; and de Petriconi R. Metabolic aspects of bowel use in urologic surgery. Ann Urol (Paris). 2007;41(5):216–236

Early Complications

Cardiovascular, respiratory, thromboembolic, and gastrointestinal complications can occur in the early postoperative course, as for any major abdominal surgery. The most common ones include wound infection or dehiscence (5–6 %), prolonged ileus (5 %), anastomotic leakage (2–4 %), catheter obstruction from mucus, ventriculoperitoneal shunt sepsis (0–20 %) [64], and peroneal nerve palsy [19]. Contemporary publications in the literature report a mortality rate of 0–3.2 % [19].

Late Complications


Asymptomatic bacteriuria in patients on CIC is nearly universal regardless of the segment considered and should not be treated except for infection with urease-splitting organisms [65]. Recurrent episodes of symptomatic cystitis do require treatment, but symptoms may be nonspecific. Risk factors predisposing to UTI include mucus accumulation, stasis, and CIC [66]. Symptomatic urinary tract infection which occurs in 5–40 % of patients [196768] requires antibiotic treatment. With regard to prophylaxis, as recommended by the European Association of Urology, low-dose, long-term, antibacterial prophylaxis may be an option for patients with recurrent UTI, but there is a risk of emergence of multiresistant organisms [69].


The incidence of calculi in augmented bladders ranges from 10 % to 50 % [7071]. Stone composition is more commonly struvite or calcium oxalate [72]. Stasis, incomplete emptying, excessive mucus production, and chronic bacteriuria, especially if urease-splitting organisms, predispose to stone formation [7374]. Patients with a continent catheterizable channel (which may not drain the bladder completely), those using urethral CIC (compared to those voiding spontaneously), and patients with urease-splitting bacteriuria are at increased risk [1975]. Permanent sutures can serve as a nidus and should be avoided as much as possible [35]. Prevention strategies include increased fluid intake, routine bladder irrigation, prompt treatment of UTI, and staple exclusion at the time of surgery [74].


Bladder perforation is a potentially life-threatening complication and is due to either overdistension or trauma from catheterization. It has been reported up to 13 % [76]. Patients with neurogenic bladders, those with competent bladder necks, those without a catheterizable channel, and those who abuse alcohol appear to be at an increased risk [197779]. Patients can present with an acute abdomen, but symptoms can be more subtle in neurologically impaired patients. The diagnosis can be made with a CT cystogram but requires a high index of suspicion [76] and low threshold for exploratory laparotomy [79]. The area of perforation is usually at the vesico-intestinal anastomosis or within the weaker bowel wall [80]. Emphasizing the importance of compliance with regular CIC can help obviate the risk of early perforation [76].

Mucus Production

The average daily mucus production is about 40 g and does not taper off with time despite villous atrophy [181]. With time, accumulated proteinaceous material can become a nidus for infection and stone or impair adequate bladder emptying [19]. Colonic segments produce more mucus than ileum [82]. Daily irrigation can help reduce mucus retention [83]. These can be augmented with acetylcysteine or urea irrigations which help dissolve mucus [82] or oral ranitidine which may help to reduce mucus production [84].

Renal Function

Renal function deterioration can occur in about 20 % of patients after AC [23]. The etiology of renal dysfunction may be urinary stone disease, bacteriuria, high detrusor pressures, vesicoureteral reflux, unrecognized obstruction, and lack of compliance with CIC [85]. The patient’s initial kidney function predicts long-term outcome, but in all cases close postoperative monitoring is warranted with periodic ultrasound imaging and laboratory studies.


Bladder cancer following AC is a recognized risk, but remains a rare complication, with an incidence of approximately 1 % [86]. The risk may be similar in patients with CIC and bladder dysfunction due to neurologic abnormalities, exstrophy, and posterior urethral valves [87]. Tumors are usually adenocarcinomas that occur at the vesico-intestinal junction [86]. The exact etiologic mechanism of the development of neoplasia is not well understood, but proposed hypotheses include chronic inflammation from prolonged exposure of the intestinal epithelium bathed in urine, the production of carcinogenic nitrosamines by chronic bacteriuria, and/or mixed cell-to-cell interactions from juxtaposition of tissues from two different origins: intestinal and urothelial [8890]. We do advocate routine surveillance with endoscopy and urine cytology on a long-term basis despite inconsistent evidence to support it, considering the long latency period of about 15 years [9192]. Although there is currently no consensus, we begin surveillance about 5–10 years after initial surgery and follow patients every year or every other year thereafter.

Metabolic Disturbances

Translocation of functional enteric epithelium into the urinary tract can result in electrolyte and acid–base abnormalities which are directly related to the segment of intestine used, the amount of time urine spends in contact with the bowel mucosa, and renal function [3893]. The length of bowel segment used in AC is usually relatively short which partly reduces the incidence of metabolic disorders compared to other types of diversion [94]. The classic electrolyte pattern for ileum and colon is hyperchloremic metabolic acidosis [39], from net absorption of NH4 and to a lesser extent bicarbonate losses [95]. Low serum potassium as well as hypocalcemia and hypomagnesemia can also occur, but they are less common.

Nutritional disorders are rare if the surgeon spares the terminal ileum, which is the sole site of absorption for vitamin B12. Resection of the distal 20 cm should be avoided to prevent such deficiency which may cause megaloblastic anemia and neurologic changes [95]. If more than 100 cm of ileum is resected, lipid malabsorption is virtually inevitable and there is also fat-soluble vitamin (A, D, E, and K) malabsorption [96].

When stomach is used, a hypokalemic hypochloremic metabolic alkalosis can occur [97]. The exclusion of a jejunal segment is rarely used in urology due to the severe hyponatremic hypochloremic hyperkalemic metabolic acidosis that may result [98].

Other consequences from metabolic disturbances include hyperammonemia secondary to the inability of the liver to clear it, which could lead to encephalopathy [95], and bone demineralization in adults or impaired bone growth in children [99] from chronic acidosis. Finally, certain drugs (digoxin, methotrexate, phenylalanine, antibiotics, theophylline) can be reabsorbed by the intestinal segment and cause toxicity [94].

Bowel Dysfunction

Patients can present a prolonged paralytic ileus, especially in those with neurological impairment as they often already suffer from slow transit [100]. Intestinal obstruction from adhesions can occur in the early or late postoperative setting and usually resolves with conservative management [83]. With time, removal of the ileocecal valve may yield a decreased stool transit time and result in intractable diarrhea, steatorrhea (from fat malabsorption), or distressing fecal incontinence [21].


Successful pregnancies and deliveries after AC have been reported and are becoming more common. There is a substantial rate of obstetrical complications, mostly preterm labor and preeclampsia, the latter being more challenging to diagnose considering the inaccuracy of urinalysis for proteinuria due to mucus from the enteric segment [101]. Antenatal close monitoring is recommended and should include regular midstream urine cultures [102] in order to treat any UTI and minimize the risk of renal scarring and impairment. In spite of this increased risk of ascending bacteria, pyelonephritis, and upper tract obstruction over the general population [103], lower urinary tract function is usually not adversely affected by pregnancy or delivery, as reported by Greenwell et al. [104]. Unless the patient has had bladder neck reconstruction or insertion of an artificial urinary sphincter [105], vaginal delivery seems preferable. If an elective cesarean section is necessary, a classical upper-segment rather than a lower-segment section should be favored [19], with urologic assistance to avoid the potential risk of damaging the vascular pedicle of the bowel segment, in which case eventual ischemic enteric contraction could occur [39].


From a clinical standpoint, we aim for patients to be free of symptomatic UTIs, continent, and with a stable renal function without hydronephrosis or stones. Only a few small retrospective case series (Level 4 evidence) have reported outcomes, but comparisons are difficult due to lack of standard terminology and the use of non-validated questionnaires [83]. The success rate, defined as achieving continence with or without CIC, has ranged from 67 % to 100 % [6163106]. The average rate for CIC after AC is 54 % (range 14–100 %) [104]. The improvement in quality of life for individuals undergoing enterocystoplasty is substantial. However, discrepancy exists between neuropathic and non-neuropathic patients regarding their satisfaction as assessed by means of a questionnaire. Indeed, the latter group is overall only 50–60 % satisfied on a long-term basis [11] compared to over 90 % satisfaction for the neuropathic patients [107], results that are probably largely influenced by the degree of unacceptability of the preoperative condition.

From a urodynamic standpoint, successful cases will have cystometrograms indistinguishable from normal, and on fluoroscopic studies, it has been demonstrated that the initial contraction occurs in the detrusor residue and subsequently in the intestinal segment [108]. Outflow resistance is also a critical factor to assess if patients have leakage postoperatively [108]. In any case, a delicate balance exists between continence and retention. Patients’ expectations and motivation highly influence their long-term satisfaction and sense of well-being after surgery.

The cost-effectiveness of AC has been compared to intradetrusor injections of botulinum toxin A (BTX-A) for refractory neurogenic OAB and favors BTX-A over a 5-year period. However, AC was deemed to be cheaper if the complication rate was below 14 % or if the efficacy of BTX-A was less than 5 months [109].

Overall, excellent outcomes can be expected with a combination of reliable surgical techniques in addition to careful patient selection as well as appropriate preoperative counseling and postoperative follow-up [110].


Despite the fact that this surgery has been practiced for decades, no evidence-based guidelines are available to recommend what kind of follow-up should be performed. Nevertheless, if we transpose the recommendations for urinary diversions post-cystectomy, and consider the potential complications and underlying disease of the patients, annual monitoring appears reasonable. Thus, in addition to history (focused on continence, frequency of intermittent catheterization, UTI, mucus production, etc.) and physical exam, upper urinary tract surveillance (comprising serum electrolytes, renal function tests, and imaging) starting at 6 weeks, then at longer intervals, and then annually may be done. Adequate oral fluid intake should be emphasized and those voiding spontaneously should check their post-void residuals regularly. Urinary cytology may be misleading because of the presence of a variety of cells. As previously mentioned, we advocate an annual or biennial cystoscopy to screen bowel and bladder mucosa for any suspicious change (redness, growth) or foreign body (stone, mucus). Long-term follow-up is necessary because of the persisting potential for problems over the years.

Experimental Options

Augmentation cystoplasty using either enteric or urothelial tissues is not a panacea and experimentation is ongoing in the quest for alternative tissues to use.

Since its beginning in the early 1990s, the field of tissue engineering has made tremendous progress [111]. Currently, there are two types of technologies that have been investigated. These are unseeded and seeded technologies [112]. Unseeded technology involves implantation of bioactive or resorbable synthetic matrices into the host organ and allowing the body’s natural capability to use the matrix as a scaffold for cell growth or tissue regeneration [111]. In comparison, seeded technology involves cells derived from biopsy that are expanded in vitro, seeded onto a natural (porcine small intestinal submucosa) or synthetic (polyglycolic acid) scaffold, and the composite is then placed back into the host for continued regeneration. Among the most exciting results, Kurokawa et al. have reported utilizing cultured oral mucosal epithelial cell sheets grafted on demucosalized seromuscular colonic flaps [113], while Atala et al. described a model created with autologous urothelial and muscle cells obtained from bladder biopsy seeded on collagen-polyglycolic acid scaffolds, and wrapped in omentum after implantation [114]. Unfortunately, despite significant advances in the field of bioengineering, the search for a perfect material remains experimental and ongoing, with few published trials on humans available yet [114].


Although intradetrusor botulinum toxin and sacral neuromodulation have emerged as competing minimally invasive therapeutic options, AC remains an essential component to the reconstructive urologist’s armamentarium, with the most popular technique using a detubularized patch of ileum. It provides satisfactory clinical outcomes and acceptable morbidity, but the potential for long-term complications warrants prolonged follow-up and monitoring.



Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int. 2012;109(9):1280–93.PubMed


Tizzoni G, Foggi A. Die weiderherstellung der harnblase. Zentralbl Chir. 1888;15:921–4.


von Mikulicz J. Zur Operation der angeborenen Blasenspalte. Centralbl Chir. 1899;26:641–3.


Couvelaire R. La petite vessie des tuberculeux génito-urinaires: essai de classification, places et variantes des cysto-intestinoplasties. J Urol Medicale Chir. 1950;56:381–434.PubMed


Charghi A, Charbonneau J, Gauthier GE. Colocystoplasty for bladder enlargement and bladder substitution: a study of late results in 31 cases. J Urol. 1967;97(5):849–56.PubMed


Bisgard JD. Substitution of the urinary bladder with a segment of sigmoid: an experimental study. Ann Surg. 1943;117(1):106–9.PubMedPubMedCentral


Sinaiko E. Artificial bladder from segment of stomach and study of effect of urine on gastric secretion. Surg Gynecol Obstet. 1956;102(4):433–8.PubMed


Goodwin WE, Winter CC, Barker WF. Cup-patch technique of ileocystoplasty for bladder enlargement or partial substitution. Surg Gynecol Obstet. 1959;108(2):240–4.PubMed


Elbahnasy AM, Shalhav A, Hoenig DM, Figenshau R, Clayman RV. Bladder wall substitution with synthetic and non-intestinal organic materials. J Urol. 1998;159(3):628–37.PubMed


Lapides J, Diokno AC, Gould FR, Lowe BS. Further observations on self-catheterization. J Urol. 1976;116(2):169–71.PubMed


Smith A, Dmochowski R, Hilton P, et al. Surgery for urinary incontinence in women. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence—4th international consultation. 2009th ed. Paris: Health Publications; 2009. p. 1239–40.


Scales CD, Wiener JS. Evaluating outcomes of enterocystoplasty in patients with spina bifida: a review of the literature. J Urol. 2008;180(6):2323–9.PubMed


Kaefer M, Pabby A, Kelly M, Darbey M, Bauer SB. Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele. J Urol. 1999;162(3 Pt 2):1068–71.PubMed


Lendvay TS, Cowan CA, Mitchell MM, Joyner BD, Grady RW. Augmentation cystoplasty rates at children’s hospitals in the United States: a pediatric health information system database study. J Urol. 2006;176(4 Pt 2):1716–20.PubMed


Reyblat P, Ginsberg D. Augmentation cystoplasty: what are the indications? [Review]. Curr Urol Rep. 2008;9(6):452–8.PubMed


Gormley EA, Lightner DJ, Burgio KL, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.PubMed


Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162–70.PubMed


Dinckan A, Turkyilmaz S, Tekin A, et al. Simultaneous augmentation ileo-cystoplasty in renal transplantation. Urology. 2007;70(6):1211–4.PubMed


Greenwell TJ, Venn SN, Mundy AR. Augmentation cystoplasty. BJU Int. 2001;88(6):511–25.PubMed


Elliott SP, Meng MV, Anwar HP, Stoller ML. Complete laparoscopic ileal cystoplasty. Urology. 2002;59(6):939–43.PubMed


Rao PKIA, Sabanegh ES. Augmentation cystoplasty. http://emedicine.medscape.com/article/443916-overview (2013). Accessed 31 Mar 2013.


Sajadi KP, Goldman HB. Bladder augmentation and urinary diversion for neurogenic LUTS: current indications. Curr Urol Rep. 2012;13(5):389–93.PubMed


Stone AR, Nanigian D. Augmentation cystoplasty for overactive bladder. In: Kreder K, Dmochowski R, editors. The overactive bladder: evaluation and management. London: Informa Healthcare; 2007. p. 359–69.


Bucher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg. 2004;139(12):1359–64. discussion 1365.PubMed


Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249(2):203–9.PubMed


Belsey J, Epstein O, Heresbach D. Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol. Aliment Pharmacol Ther. 2009;29(1):15–28.PubMed


Franga DL, Harris JA. Polyethylene glycol-induced pancreatitis. Gastrointest Endosc. 2000;52(6):789–91.PubMed


Committee ADRA. Electrolyte disturbances with oral phosphate bowel preparations. Aust Adv Drug React Bull 1997;16(2) p. 5.


Gundeti MS, Godbole PP, Wilcox DT. Is bowel preparation required before cystoplasty in children? J Urol. 2006;176(4 Pt 1):1574–6. discussion 1576–1577.PubMed


Victor D, Burek C, Corbetta JP, et al. Augmentation cystoplasty in children without preoperative mechanical bowel preparation. J Pediatr Urol. 2012;8(2):201–4.PubMed


Canning DA. Re: Augmentation cystoplasty in children without preoperative mechanical bowel preparation. J Urol. 2012;188(6):2368–9.


Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132.PubMed


Wolf JS, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379–90.PubMed


Bailly GG, Herschorn S. Urinary Diversion. In: Corcos J, Schick E, editors. Textbook of the neurogenic bladder. 2nd ed. London: Informa Healthcare; 2008. p. 670–85.


Abou-Elela A. Augmentation cystoplasty: in pretransplant recipients. In: Ortiz J, Andre J, editors. Understanding the complexities of kidney transplantation. Rijeka: InTech; 2011. p. 279–330.


Adams MC, Joseph DB. Augmentation cystoplasty. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology, vol. IV. 10th ed. Philadelphia, PA: Saunders, Elsevier; 2012. p. 3471–91.


Hendren WH, Hendren RB. Bladder augmentation: experience with 129 children and young adults. J Urol. 1990;144(2 Pt 2):445–53. discussion 460.PubMed


Duel BP, Gonzalez R, Barthold JS. Alternative techniques for augmentation cystoplasty. J Urol. 1998;159(3):998–1005.PubMed


Herschorn S, Welk BK. Bladder augmentation. In: Goldman HB, editor. Complications of female incontinence and pelvic reconstructive surgery. Cleveland, OH: Humana; 2013. p. 171–87.


Fromm D. Ileal resection, or disease, and the blind loop syndrome: current concepts of pathophysiology. Surgery. 1973;73(5):639–48.PubMed


Gosalbez R, Woodard JR, Broecker BH, Parrott TS, Massad C. The use of stomach in pediatric urinary reconstruction. J Urol. 1993;150(2 Pt 1):438–40.PubMed


Sumfest JM, Mitchell ME. Gastrocystoplasty in children. Eur Urol. 1994;25(2):89–93.PubMed


Nguyen DH, Bain MA, Salmonson KL, Ganesan GS, Burns MW, Mitchell ME. The syndrome of dysuria and hematuria in pediatric urinary reconstruction with stomach. J Urol. 1993;150(2 Pt 2):707–9.PubMed


Clark SS. Electrolyte disturbance associated with jejunal conduit. J Urol. 1974;112(1):42–7.PubMed


Klein EA, Montie JE, Montague DK, Kay R, Straffon RA. Jejunal conduit urinary diversion. J Urol. 1986;135(2):244–6.PubMed


Churchill BM, Aliabadi H, Landau EH, et al. Ureteral bladder augmentation. J Urol. 1993;150(2 Pt 2):716–20.PubMed


Hitchcock RJ, Duffy PG, Malone PS. Ureterocystoplasty: the ‘bladder’ augmentation of choice. Br J Urol. 1994;73(5):575–9.PubMed


Johal NS, Hamid R, Aslam Z, Carr B, Cuckow PM, Duffy PG. Ureterocystoplasty: long-term functional results. J Urol. 2008;179(6):2373–5. discussion 2376.PubMed


MacNeily AE, Afshar K, Coleman GU, Johnson HW. Autoaugmentation by detrusor myotomy: its lack of effectiveness in the management of congenital neuropathic bladder. J Urol. 2003;170(4 Pt 2):1643–6. discussion 1646.PubMed


Redman JF, Barthold JS. Experience with ileal augmentation cystoplasty using a short pfannenstiel incision. J Urol. 1996;155(5):1726–7.PubMed


Aleman MA, Abdelmalak JB, Rackley RR. Augmentation cystoplasty. In: Goldman HB, Vasavada SP, editors. Current clinical urology: female urology: a practical clinical guide. Totowa, NJ: Humana; 2007. p. 251–9.


Blaivas JG, Weiss J, Desai P, Flisser AJ, Stember D, Stahl P. Long-term followup of augmentation enterocystoplasty and continent diversion in patients with benign disease. J Urol. 2005;173(5):1631–4.PubMed


Gil Vernet SG. Neurogenic bladder, neuromuscular bladder and intestinal bladder. Acta Urol Belg. 1962;30:405–20.PubMed


Adams MC, Joseph DB. Urinary tract reconstruction in children. In: Wein A, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology, vol. 4. Philadelphia: Saunders, Elsevier; 2007. p. 3656–702.


Rackley RR, Abdelmalak JB. Laparoscopic augmentation cystoplasty. Surgical technique. Urol Clin North Am. 2001;28(3):663–70.PubMed


Gill IS, Rackley RR, Meraney AM, Marcello PW, Sung GT. Laparoscopic enterocystoplasty. Urology. 2000;55(2):178–81.PubMed


Kang IS, Lee JW, Seo IY. Robot-assisted laparoscopic augmentation ileocystoplasty: a case report. Int Neurourol J. 2010;14(1):61–4.PubMedPubMedCentral


Meng MV, Anwar HP, Elliott SP, Stoller ML. Pure laparoscopic enterocystoplasty. J Urol. 2002;167(3):1386.PubMed


Inman BA, Harel F, Tiguert R, Lacombe L, Fradet Y. Routine nasogastric tubes are not required following cystectomy with urinary diversion: a comparative analysis of 430 patients. J Urol. 2003;170(5):1888–91.PubMed


Botto H, Naber KG, Bishop MC, Jarlier V, Lim V, Norby R. Antimicrobial policy in prophylaxis and treatment of nosocomial urinary tract infection. In: Naber KG, Pechere JC, Kumazawa J, Khoury S, Gerberding JL, Schaeffer AJ, editors. Nosocomial and health care associated infections in urology. Plymouth: Health Publications; 2001. p. 177–92.


Flood HD, Malhotra SJ, O’Connell HE, Ritchey MJ, Bloom DA, McGuire EJ. Long-term results and complications using augmentation cystoplasty in reconstructive urology. Neurourol Urodyn. 1995;14(4):297–309.PubMed


Welk B, Herschorn S, Law C, Nam R. Population based assessment of enterocystoplasty complications in adults. J Urol. 2012;188(2):464–9.PubMed


Herschorn S, Hewitt R. Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder. Urology. 1998;52(4):672–8.PubMed


Yerkes EB, Rink RC, Cain MP, Luerssen TG, Casale AJ. Shunt infection and malfunction after augmentation cystoplasty. J Urol. 2001;165(6 Pt 2):2262–4.PubMed


Akerlund S, Campanello M, Kaijser B, Jonsson O. Bacteriuria in patients with a continent ileal reservoir for urinary diversion does not regularly require antibiotic treatment. Br J Urol. 1994;74(2):177–81.PubMed


Worth PH. The treatment of interstitial cystitis by cystolysis with observations on cystoplasty. A review after 7 years. Br J Urol. 1980;52(3):232.PubMed


Khoury J, Timmons S, Corbel L, Webster G. Complications of enterocystoplasty. Urology. 1992;40(1):9–14.PubMed


Mitchell M, Kulb T, Backes D. Intestinocystoplasty in combination with clean intermittent catheterization in the management of vesical dysfunction. J Urol. 1986;136(1 Pt 2):288–91.PubMed


Stöhrer M, Blok B, Castro-Diaz D, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Uroweb. 2011. http://www.uroweb.org/guidelines/online-guidelines/. Accessed 11 Jan 2014.


Palmer LS, Franco I, Kogan SJ, Reda E, Gill B, Levitt SB. Urolithiasis in children following augmentation cystoplasty. J Urol. 1993;150(2 Pt 2):726–9.PubMed


Sakakibara R, Hattori T, Uchiyama T, Kamura K, Yamanishi T. Uroneurological assessment of spina bifida cystica and occulta. Neurourol Urodyn. 2003;22(4):328–34.PubMed


Benway BM, Bhayani SM. Lower urinary tract calculi. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology, vol. III. 10th ed. Philadelphia: Saunders, Elsevier; 2012. p. 2521–30.


Khoury AE, Salomon M, Doche R, et al. Stone formation after augmentation cystoplasty: the role of intestinal mucus. J Urol. 1997;158(3 Pt 2):1133–7.PubMed


DeFoor W, Minevich E, Reddy P, et al. Bladder calculi after augmentation cystoplasty: risk factors and prevention strategies. J Urol. 2004;172(5 Pt 1):1964–6.PubMed


Nurse D, McInerney P, Thomas P, Mundy A. Stones in enterocystoplasties. Br J Urol. 1996;77(5):684–7.PubMed


DeFoor W, Tackett L, Minevich E, Wacksman J, Sheldon C. Risk factors for spontaneous bladder perforation after augmentation cystoplasty. Urology. 2003;62(4):737–41.PubMed


Novak T, Salmasi A, Mathews R, Lakshmanan Y, Gearhart J. Complications of complex lower urinary tract reconstruction in patients with neurogenic versus nonneurogenic bladder—is there a difference? J Urol. 2008;180(6):2629–34.PubMed


Fox J, Husmann D. Continent urinary diversion in childhood: complications of alcohol abuse developing in adulthood. J Urol. 2010;183(6):2342–6.PubMed


Metcalfe PD, Casale AJ, Kaefer MA, et al. Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. J Urol. 2006;175(4):1466–70. discussion 1470–1461.PubMed


Braverman RM, Lebowitz RL. Perforation of the augmented urinary bladder in nine children and adolescents: importance of cystography. AJR Am J Roentgenol. 1991;157(5):1059–63.PubMed


Murray K, Nurse DE, Mundy AR. Secreto-motor function of intestinal segments used in lower urinary tract reconstruction. Br J Urol. 1987;60(6):532–5.PubMed


Gillon G, Mundy AR. The dissolution of urinary mucus after cystoplasty. Br J Urol. 1989;63(4):372–4.PubMed


Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol. 2004;22(3):157–67.PubMed


George V, Gee J, Wortley M, Stott M, Gaches C, Ashken M. The effect of ranitidine on urine mucus concentration in patients with enterocystoplasty. Br J Urol. 1992;70(1):30–2.PubMed


Fontaine E, Leaver R, Woodhouse CR. The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up. BJU Int. 2000;86(3):195–8.PubMed


Soergel TM, Cain MP, Misseri R, Gardner TA, Koch MO, Rink RC. Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder. J Urol. 2004;172(4 Pt 2):1649–51. discussion 1651–1642.PubMed


Higuchi T, Granberg C, Fox J, Husmann D. Augmentation cystoplasty and risk of neoplasia: fact, fiction and controversy. J Urol. 2010;184(6):2492–6.PubMed


Husmann DA, Rathbun SR. Long-term follow up of enteric bladder augmentations: the risk for malignancy. J Pediatr Urol. 2008;4(5):381–5. discussion 386.PubMed


Filmer RB, Spencer JR. Malignancies in bladder augmentations and intestinal conduits. J Urol. 1990;143(4):671–8.PubMed


Balachandra B, Swanson PE, Upton MP, Yeh MM. Adenocarcinoma arising in a gastrocystoplasty. J Clin Pathol. 2007;60(1):85–7.PubMedPubMedCentral


Golomb J, Klutke CG, Lewin KJ, Goodwin WE, deKernion JB, Raz S. Bladder neoplasms associated with augmentation cystoplasty: report of 2 cases and literature review. J Urol. 1989;142(2 Pt 1):377–80.PubMed


Hamid R, Greenwell TJ, Nethercliffe JM, Freeman A, Venn SN, Woodhouse CR. Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary? BJU Int. 2009;104(3):392–5.PubMed


Koch MO, McDougal WS, Reddy PK, Lange PH. Metabolic alterations following continent urinary diversion through colonic segments. J Urol. 1991;145(2):270–3.PubMed


de Petriconi R. Metabolic aspects of bowel use in urologic surgery. Ann Urol (Paris). 2007;41(5):216–36.


Gilbert SM, Hensle TW. Metabolic consequences and long-term complications of enterocystoplasty in children: a review. J Urol. 2005;173(4):1080–6.PubMed


Burkhard FC, Kessler TM, Mills R, Studer UE. Continent urinary diversion. Crit Rev Oncol Hematol. 2006;57(3):255–64.PubMed


Gosalbez R, Woodard JR, Broecker BH, Warshaw B. Metabolic complications of the use of stomach for urinary reconstruction. J Urol. 1993;150(2 Pt 2):710–2.PubMed


Tanrikut C, McDougal WS. Acid-base and electrolyte disorders after urinary diversion. World J Urol. 2004;22(3):168–71.PubMed


Hochstetler JA, Flanigan MJ, Kreder KJ. Impaired bone growth after ileal augmentation cystoplasty. J Urol. 1997;157(5):1873–9.PubMed


Singh G, Thomas DG. Bowel problems after enterocystoplasty. Br J Urol. 1997;79(3):328–32.PubMed


Niknejad KG, Atala A. Bladder augmentation techniques in women. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(3):156–69.PubMed


Fenn N, Barrington JW, Stephenson TP. Clam enterocystoplasty and pregnancy. Br J Urol. 1995;75(1):85–6.PubMed


Hautmann RE, Volkmer BG. Pregnancy and urinary diversion. Urol Clin North Am. 2007;34(1):71–88.PubMed


Greenwell TJ, Venn SN, Creighton S, Leaver RB, Woodhouse CR. Pregnancy after lower urinary tract reconstruction for congenital abnormalities. BJU Int. 2003;92(7):773–7.PubMed


Hill DE, Kramer SA. Management of pregnancy after augmentation cystoplasty. J Urol. 1990;144(2 Pt 2):457–9. discussion 460.PubMed


Kreder K, Das AK, Webster GD. The hemi-Kock ileocystoplasty: a versatile procedure in reconstructive urology. J Urol. 1992;147(5):1248–51.PubMed


Hasan ST, Marshall C, Robson WA, Neal DE. Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction. Br J Urol. 1995;76(5):551–7.PubMed


Futter NG, Collins WE. Intestinal cystoplasty. Long-term functional result. Urology. 1974;3(4):434–6.PubMed


Padmanabhan P, Scarpero HM, Milam DF, Dmochowski RR, Penson DF. Five-year cost analysis of intra-detrusor injection of botulinum toxin type A and augmentation cystoplasty for refractory neurogenic detrusor overactivity. World J Urol. 2011;29(1):51–7.PubMed


Khavari R, Fletcher SG, Liu J, Boone TB. A modification to augmentation cystoplasty with catheterizable stoma for neurogenic patients: technique and long-term results. Urology. 2012;80(2):460–4.PubMed


Stanasel I, Mirzazadeh M, Smith JJ. Bladder tissue engineering. Urol Clin North Am. 2010;37(4):593–9.PubMed


Colvert JR, Kropp BP, Cheng EY. Bladder augmentation: current and future techniques. AUA Update Ser. 2003;22(32):250.


Kurokawa S, Morita T, Shiroyanagi Y, Yamato M, Okano T, Kobayashi E. Novel augmentation cystoplasty utilizing cultured oral mucosal epithelial cell sheets grafted on demucosalized seromuscular colonic flaps. Eur Urol Suppl. 2007;6(2):96. abstract 294.


Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB. Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet. 2006;367(9518):1241–6.PubMed

If you find an error or have any questions, please email us at admin@doctorlib.info. Thank you!