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Background <p>Augmentation cystoplasty (AC) is traditionally reserved for end-stage small-capacity bladders. Increasing evidence suggests that earlier intervention in patients with borderline bladder capacity may preserve bladder function and protect the upper urinary tract. We evaluated long-term functional, urodynamic, renal, and quality-of-life outcomes of early augmentation cystoplasty in adults with borderline bladder capacity.</p> Methods <p>This retrospective observational study included 40 adult patients with borderline bladder capacity (100–170 mL) who underwent open ileocystoplasty at a tertiary referral center between 2015 and 2024. All patients had refractory storage lower urinary tract symptoms despite maximal medical therapy. Pre- and postoperative assessments included urodynamics, renal function, vesicoureteral reflux (VUR), continence status, need for clean intermittent catheterization (CIC), and validated quality-of-life questionnaires. Mean follow-up duration was 6 years.</p> Results <p>The mean age was 41.2 years; etiologies included neurogenic bladder (45%), genitourinary tuberculosis (42%), post-radiation cystitis (7.5%), and others. Mean bladder capacity increased from 139.6 ± 16.6 mL to 282 ± 12.4 mL (<i>p</i> &lt; 0.05), and compliance improved from 17 to 40 mL/cm H₂O (<i>p</i> &lt; 0.05). Mean detrusor filling pressure decreased from 46 to 13.6&#xa0;cm H₂O (<i>p</i> &lt; 0.05). Continence was achieved in 95% of patients; 67.5% voided spontaneously and 32.5% required CIC. Serum creatinine improved significantly (1.77 to 1.41&#xa0;mg/dL; <i>p</i> &lt; 0.05), with no deterioration in renal function during follow-up. Among patients managed without ureteric reimplantation, VUR resolved in 81.3% and downgraded in the remainder. Late complications included bladder stones in 10% and recurrent urinary tract infections in 5%. No malignancy or significant metabolic complications were observed.</p> Conclusions <p>Early augmentation cystoplasty in adults with borderline bladder capacity provides durable improvement in bladder function, continence, and quality of life, while preserving renal function and effectively resolving pressure-dependent vesicoureteral reflux. Timely surgical intervention, rather than delayed treatment in end-stage disease, may prevent irreversible bladder and renal damage with acceptable long-term morbidity.</p>

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Early augmentation cystoplasty in adults with borderline bladder capacity: long-term functional and renal outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月13日

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  • Abdul Rouf Khawaja,
  • Syed Shakeeb Arsalan,
  • Uvaisullah Quadir,
  • Sajad Sultan Lone,
  • Sajad Ahmad Para,
  • Saqib Mehdi,
  • Sajad Ahmad Malik,
  • Arif Hamid Bhat,
  • Gokul Kannan,
  • Aamir Bashir Raina

摘要

Background

Augmentation cystoplasty (AC) is traditionally reserved for end-stage small-capacity bladders. Increasing evidence suggests that earlier intervention in patients with borderline bladder capacity may preserve bladder function and protect the upper urinary tract. We evaluated long-term functional, urodynamic, renal, and quality-of-life outcomes of early augmentation cystoplasty in adults with borderline bladder capacity.

Methods

This retrospective observational study included 40 adult patients with borderline bladder capacity (100–170 mL) who underwent open ileocystoplasty at a tertiary referral center between 2015 and 2024. All patients had refractory storage lower urinary tract symptoms despite maximal medical therapy. Pre- and postoperative assessments included urodynamics, renal function, vesicoureteral reflux (VUR), continence status, need for clean intermittent catheterization (CIC), and validated quality-of-life questionnaires. Mean follow-up duration was 6 years.

Results

The mean age was 41.2 years; etiologies included neurogenic bladder (45%), genitourinary tuberculosis (42%), post-radiation cystitis (7.5%), and others. Mean bladder capacity increased from 139.6 ± 16.6 mL to 282 ± 12.4 mL (p < 0.05), and compliance improved from 17 to 40 mL/cm H₂O (p < 0.05). Mean detrusor filling pressure decreased from 46 to 13.6 cm H₂O (p < 0.05). Continence was achieved in 95% of patients; 67.5% voided spontaneously and 32.5% required CIC. Serum creatinine improved significantly (1.77 to 1.41 mg/dL; p < 0.05), with no deterioration in renal function during follow-up. Among patients managed without ureteric reimplantation, VUR resolved in 81.3% and downgraded in the remainder. Late complications included bladder stones in 10% and recurrent urinary tract infections in 5%. No malignancy or significant metabolic complications were observed.

Conclusions

Early augmentation cystoplasty in adults with borderline bladder capacity provides durable improvement in bladder function, continence, and quality of life, while preserving renal function and effectively resolving pressure-dependent vesicoureteral reflux. Timely surgical intervention, rather than delayed treatment in end-stage disease, may prevent irreversible bladder and renal damage with acceptable long-term morbidity.