Population Based Assessment of Enterocystoplasty Complications in Adults

Purpose: Enterocystoplasty can be used to treat several types of bladder dysfunction. We conducted a population based study to identify the rate and significant predictors of urological surgery after adult enterocystoplasty. Materials and Methods: A retrospective, population based cohort was assembled using administrative data records, and adults who underwent enterocystoplasty between 1993 and 2009 were included in the analysis. Administrative data sources were used to measure primary exposure (neurogenic bladder and concurrent catheterizable channel or anti-incontinence procedure) and primary outcome (urological surgical procedures after enterocystoplasty). Multivariable Cox proportional hazards models were used (covariates of age, gender, Charlson score and socioeconomic status). Results: We identified 243 patients, of whom 61% had a neurogenic bladder, 20% had a simultaneous incontinence procedure and 18% underwent creation of a catheterizable channel. Median followup was 7.8 years (IQR 4.0-12.2). The proportion of patients who required a subsequent urological procedure was 40% (0.098 procedures per person-year of followup). A simultaneous incontinence procedure at enterocystoplasty was a significant predictor of future surgical procedures (HR 1.47, 95% CI 1.02-2.12, p = 0.0414). Cystolitholapaxy was the most common subsequent procedure (25% of patients) and a catheterizable channel conferred a significant risk of cystolitholapaxy (HR 2.92, 95% CI 1.461-5.85, p = 0.0024). Conclusions: Repeat urological surgery is common after enterocystoplasty. Patients who require a simultaneous incontinence procedure at enterocystoplasty are more likely to require future surgery. Patients with catheterizable channels are at significant risk for future cystolitholapaxy.