Autoaugmentation Following Clean Intermittent Self-catheterization In The Treatment Of Hyperreflexia Neurogenic Bladder

ObjectiveAugmentation cystoplasty is now used quit commonly for reconstruction of the dysfunction baldder when more conservation management fails. Because of the significant of complica-tions and side effects related to removal of a gastrointestinal segment or its incorpora-tion into the urinary tract, we assess the autoaugmentation following clean intermitten self-catheterization in the treatment of hyperreflexia neurogenic bladder.In the urology neurogenic baldder is one of the common intractable neurologic disease. Most lesions above the level of the cord where the micturition center is located will cause bladder spasticity.Sacral reflex arcs remain intact, but loss of inhibition from higher centers results in spastic baldder and sphincter behavoir on the segmental level. Common lesions found above the brain stem that affect voiding include dementia, vascular accidents, multiple sclerosis, tumors, and inflammatory disorders such as encephalitis or meningitis. These lesions can produce a wide range of functional changes, including urgence, frequence retention of urine,recurrent urinary tract infections, and gross incontnence. the spastic baldder is tyified by (1) reduced capacity, (2) involubtary detrusor contraction, (3) high intravesical voiding pressure, (4) marked hypertrophy of the bladder wall, (5) spasticity of the pelvic striated muscle, (6) autonomic dysreflexia in cervical cord lesions. Now the treatment of hyperreflexia or overactive neuropathic bladder are categorized as follow:(l) a permanent indwelling catheter, (2) sphincterotomy, (3) sacral rhizotomy, (4) neuri-stimulation of the sacral nerve roots, (5) urinary division including the standard ileal conduit, cutaneous ureterotomies.and ect, (6) augmentation cystoplasty. (7) autoaugmenta-tion.our institute is using the autoaugmentation following clean intermittent self-catheteriza-tion in the treatment of hyperreflexia neurogenic bladder for reconstruction of thedysfunc-tion bladder when more conservation and mini-trauma mangement fail, through following-up we not noly compare with the results of pre- and post-operative clinic symptoms and signs and urodynamic studies but also estimate its effect and accummulate some experiences. Now report it as follow: Material and methodsurgical technique: autoaugmentation is performed through a midline lower abdominal incision.dissect the peritoneum from the dome of the bladder.With the electrocautery set for coagula-tion, incise through three quarters of the thickness of the detrusor with a vertical midline incision over the entire dome, bluntly and sharply dissect laterally in the plane between detrusor muscle and urothelium until half of the wall is peeled back, leaving the mucose in-tact to protrude as a bulge. Fill and drain the bladder intermittently to aid the dissection.Close any holes with 5-0 SAS. the detrusor flaps is excised laterally in each direction from the bulging mucosa. The lateral edges of the detrusor muscle are secured to the psoas muscle bilaterally to prevent collapse of a large augmenting bulge. Drain the bladder with a Foley catheter. Place a Penrose drain paravesically. During the recovery period, it is important to distend the autoaugmentation. This can be done by filling to a predetermined volume twice daily and clamping the catheter for 30 minutes, constant pressure may be achieved by elevating the catheter drainage tubing to 40 cm above bladder level. At 7 days, if cystography shows no leakage, the catheter is removed and intermittent catheterization is begun.We reviewed our use of autoaugmentation in the treatment of hyperreflexia neurogenic baldder in 40 cases patients and analyzed the results from volume at first desire to void, maximum cystome-tric capacity, maximal detrusor pressure, maximum urethral pressure, maximum urethral closure pressure, renal function and clinic presentations retrospectively, all patients were followed up from 6 months to 9 years, a mean of 6.7 years, complete continence was found in 35 patients. There was a significantly improvement in renal function in 21 cases among 27 cases. Bladder compliance of all patients were improved in the postoperation.Result1.There are obvious advantages to autoaugmentation and its variables for hyperreflexianeurogenic bladder,including intravesical pressure and detrusor uninhibitor contraction significantly decreased, cystometric capacity, volume at the firstdesire to void, and maximum cystometric capacity increased. The maximum detrusor pressure fell (P<0.01). Its variables have a evident differential.2.Autoaugmentation block partial nerve factors resulting in bladder overactivity and increase bladder compliance.S.Autoaugmentation avoids the complications of intestinocystoplasty and electrolyte disturbance. ConclusionIt is a easy and reliable procedure in the treatment of hyperreflexia neurogenic bladder.