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The Problems of Substitution Cystoplasty
Author(s) -
NURSE D. E.,
McCRAE P.,
STEPHENSON T. P.,
MUNDY A. R.
Publication year - 1988
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1988.tb06589.x
Subject(s) - medicine , weakness , complication , sphincter , surgery , urinary incontinence , muscle weakness
Summary— Substitution cystoplasty was performed in 157 patients aged 4 to 71 years; 62% suffered no post‐operative complication. The commonest complication was sphincter‐weakness incontinence, found in 18%, mainly in patients having a cystoplasty for interstitial cystitis; it was rare for the patient to complain of this incontinence. Ten per cent suffered incontinence due to colonic overactivity and this occurred in patients with neuropathic sphincter‐weakness incontinence or an artificial sphincter; all of these patients complained of their incontinence. This was corrected by “patching” in all cases. Voiding difficulties requiring clean intermittent self‐catheterisation occurred in 15%. More worrying was the universal finding, when looked for by blood gas analysis, of a metabolic acidosis with respiratory compensation. It was concluded that in the absence of neuropathy, sphincter weakness or an artificial sphincter, an unmodified ileocaecal segment substitution cystoplasty is adequate; in the presence of neuropathy, sphincter weakness or an artificial sphincter, a “pouch” type of substitution cystoplasty should be performed. All patients should have blood gas analyses from time to time as part of their routine post‐operative follow‐up.