Augmentation cystoplasty (AC) is now commonly performed to 
reconstruct the low urinary tract for patients with bladder dysfunction. Whether coinstantaneous ureteral reimplantation is preformed spark controversy. Few teams claim simultaneous ureteral reimplantation is not necessary during AC, while the others argue that concomitant ureteral reimplantation or vesicoureteral anti-reflux procedure should be performed. To review and evaluate the efficacy and complications of new reconstructive procedure----augmentation uretero-enterocystoplasty (AUEC) in adult and juvenile patients with lower urinary tract dysfunction at (LUTD) our center during 16 years.

The medical records of 210 patients who received AUEC at our center from 2003 to 2019 were reviewed. The clinical records, video-urodynamic (VUD) data and magnetic resonance urography (MRU) of these patients were collected. International vesico-ureteral reflux (VUR) and upper urinary tract dilatation (UUTD) grading systems were applied to assess upper urinary tract (UUT) function. Post-operative complications were put into analysis and assessment.

There are 153 males and 57 females in this retrospective study, age 4-67 years, mean age 28.1 years. One hundred and seventy one of 210 were neurogenic causes, 9 non-neurogenic causes and 30 idiopathic causes. There are total 338 ureteral units simultaneously preformed re-implantation and all units underwent ureterolysis and/or cutting. The average medical history and mean follow-up time were 13.5 years (range from 0.3 to 56 years) and 57.4 (range from 1 to 151 months) months, respectively. Ileum intestine and sigmoid segments were respectively adopted in 10 (4.8%) and 200 (95.2%) cases. Mean ureteral indwelling time is 35.6 days. Max detrusor pressure, bladder compliance and mean maximum bladder capacity significantly improved (p<0.01). After operation, Scr level has no significant change in the group with normal renal function (p >0.05); but Scr level decreased significantly in the group with abnormal renal function after 1 year of operation (p<0.01). VUR, UUTD and urinary incontinence were improved significantly by the procedure. The complications included metabolic acidosis (20 cases, 9.5%), vesico-ureteral anastomosis stenosis (13 cases, 6.2%), persistent VUR (6 cases, 2.8%), urinary calculi (14 cases, 6.6%) and intestinal dysfunction requiring laparotomy (8 cases, 3.8%).

Long-term VUD results showed that AUEC  increased bladder compliance and BC and decreased detrusor pressure significantly. Comparing the preoperative and postoperative MRU parameters, it was found that AUEC could significantly improve hydronephrosis and dilated and/or tortuous UUT.  In terms of renal function changes, there was almost no significant change in the preoperative Scr level normal group; but in the preoperative Scr level abnormal group, the long-term follow-up consequence of renal function was unstable. This may indicate that although AUEC can not improve the renal function of all patients, it plays an important role in stabilizing renal function and protecting the UUT from further deterioration.

This retrospective study showed that AUEC played a positive role in treatment for the refractory LUTD patients with hydronephrosis, UUTD, ureteral tortuosity, adhesion or stenosis and VUR. For the protection of renal function, it may be better to do it at the early stage of the disease.

Liao L, Zhang F and Chen G: New grading system for upper urinary tract dilation using magnetic resonance urography in patients with Neurogenic Bladder. BMC Urol 2014; 14: 38.
Liao L: A new comprehensive classification system for both lower and upper urinary tract dysfunction in patients with neurogenic bladder. Urol Int 2015; 94: 244.
Zhaoxia Wang ,Limin Liao. Effectiveness and Complications of Augmentation Cystoplasty with or without Nonrefluxing Ureteral Reimplantation in Patients with Bladder Dysfunction: A Single Center 11-Year Experience. J. Urol. 2018 01;199(1): 200-205