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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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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