Augmentation Cystoplasty and Risk of Neoplasia: Fact, Fiction and Controversy

Purpose: We determined if ileal/colonic bladder augmentation performed in patients with congenital bladder abnormalities is an independent risk factor for bladder malignancy. Materials and Methods: We reviewed a registry of patients with bladder dysfunction due to neurological abnormalities, exstrophy and posterior urethral valves. Individuals treated with augmentation cystoplasty were matched (1: 1) to a control group treated with intermittent catheterization based on etiology of bladder dysfunction, gender and age (+/- 2 years). Results: We evaluated 153 patients with an ileal/colonic cystoplasty and a matched control population. There was no difference (p = 0.54) in the incidence of bladder cancer in patients with augmentation cystoplasty (7 patients [4.6%]) vs controls (4 [2.6%]). In addition, there was no difference between the 2 groups regarding age at diagnosis (51 vs 49.5 years, p > 0.7), stage (3.4 vs 3.8, p > 0.5), mortality rate (5 of 7 [71%] vs 4 of 4 [100%], p > 0.4) or median survival (18 vs 17 months, p > 0.8). Irrespective of augmentation status patients with a history of renal transplant on chronic immunosuppression had a significantly higher incidence of bladder cancer (3 of 20 [15%]), compared to patients who were not immunosuppressed (8 of 286 [2.8%], p = 0.03). Conclusions: In patients with congenital bladder dysfunction ileal/colonic bladder augmentation does not appear to increase the risk of bladder malignancy over the inherent cancer risk associated with the underlying congenital abnormality. In addition, immunosuppression irrespective of bladder treatment is an independent risk factor for malignancy in this patient population.