Clinical outcome and quality of life after enterocystoplasty for contracted bladders.

From 1989 to 1995, a total of 21 patients underwent enterocystoplasty in order to increase their bladder capacity and decrease intravesical pressure. Of these, 18 had neuropathic bladders caused by spinal cord injuries and 3 had contracted bladders caused by irradiation cystitis following treatment of cervical cancer. Enterocystoplasty was performed using a 40-cm segment of terminal ileum. The postoperative follow-up periods ranged from 6 to 80 months (mean 36 months). Twelve patients, who had had preoperative hydronephrosis, showed complete resolution after enterocystoplasty. Sixteen patients, suffering from intractable urinary incontinence preoperatively, regained continence after surgery while 2 continued to have mild urgent or stress incontinence. Their mean bladder capacities were 165 +/- 97 ml preoperatively and 760 +/- 289 ml postoperatively. The end-filling pressures were 50 +/- 23 cm H2O preoperatively and 13 +/- 4.7 cm H2O postoperatively. Sixteen patients could urinate smoothly, but 12 of them occasionally needed intermittent catheterization in order to evacuate residual urine. Nineteen patients were satisfied with their surgical result, whereas 1 wished to become completely dry, and 1 could not be catheterized because of poor family support. All but 1 of the patients declared that the quality of life improved after surgery. In conclusion, enterocystoplasty is satisfactory treatment for contracted bladders that result in upper tract deterioration or intractable urinary incontinence. Acceptable continence was achieved in 90% of the patients and the overall satisfaction rate was 95%. Careful patient selection is necessary for achieving a good surgical outcome.