Outcomes of lower urinary and bowel function in meningomyelocele patients with augmentation enterocystoplasty

Objectives: We evaluated the outcomes of augmentation ileocystoplasty in video-urodynamics ( V-UDS) and questionnaires related to bowel and urinary function. Methods: In 22 meningomyelocele (MMC) patients ( 11 male and 11 female, a mean age at surgery 14.4 years) who underwent augmentation ileocystoplasties, V-UDS was performed before and at a median of 15 months ( 6-120 months) after the surgery and the questionnaires were answered at a median of 7.1 years ( 1.1-14.5 years) after surgery. Results: Concomitant procedures of urethral sling in four, cecostomy in four and ureteral reimplantation in two were performed at augmentation ileocystoplasty. V-UDS showed a significant improvement after the surgery in bladder capacity, bladder compliance and detrusor overactivity. Vesicoureteral reflux ( VUR) disappeared after the surgery in 16 of 19 ureters with VUR. Although questionnaire for urinary condition using International Consultation on Incontinence Questionnaire Short Form demonstrated that 80% of patients were completely free from urinary incontinence after surgery, more than a half of patients had persistent or deteriorated bowel function such as urgency of bowel movement and fecal incontinence in questionnaires for bowel function. Even with complaints in bowel function, more than 80% of MMC patients had a high level of satisfaction with augmentation enterocystoplasty in overall quality of life ( QOL). Conclusions: Benefits of augmentation ileocystoplasty were maintained in urodynamic parameters as well as urinary continence. Although augmentation ileocystoplasty generally provides high QOL for MMC patients refractory to conservative therapies, an advance of fecal management can make MMC patients' QOL superior to a current state.