Any patient with marked reduction in bladder capacity or compliance may be a candidate for augmentation cystoplasty. Conservative management for these patients usually consists of intermittent self-catheterization and anticholinergic medications. In general, augmentation cystoplasty is considered when bothersome symptoms impair a patient’s lifestyle despite medical treatment or when high-pressure urinary storage places the upper urinary tracts at risk.
Neurogenic bladder in the pediatric population is often associated with congenital anomalies, including the following:
· Prune belly syndrome (Eagle-Barrett syndrome)
· Bladder exstrophy
· Cloacal exstrophy
Patients with these conditions most commonly undergo augmentation cystoplasty when, despite behavioral and medical management, they experience continued incontinence, debilitating urgency, enuresis, complicated UTIs, vesicoureteral reflux, or impaired renal growth.
Some adult patients who underwent urinary diversion for an embryologic urinary defect as a child seek a healthier cosmetic and functional state. In other cases, adults have an acquired condition that is causing bladder dysfunction. Adults may present with symptoms very similar to those of children with congenital abnormalities. Again, surgery is indicated for adults with refractory symptoms and those with risk or progression of upper tract deterioration.