Cystoplasty management of the intractably hostile neurogenic bladder
Although most neurogenic bladder hyperactivity can be managed by pharmacologic and other conservative techniques, a small group of patients will require cystoplasty surgery to achieve a capacious docile storage reservoir. A variety of surgical variables exist including the extent of removal of existing bladder wall, the choice of bowel segment, and the shape of the remodeled segment. Most commonly, cystoplasty for simple detrusor hyperactivity (low compliance or intractable hyperreflexia) requires only clam augmentation. Many patients with intractable detrusor problems will also have alterations in sphincter function and a variety of alternative treatment choices are available for management of the incompetent outlet. Similarly, a large percentage of these patients will have associated upper tract problems such as reflux, and a variety of techniques are available for its management. The techniques chosen will be determined by a variety of factors. The results of enterocystoplasty management in this group of patients are excellent, and complications are uncommon.
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