Long-term Survival of Bladder Augmentation is Influenced by its Shape and Mucosal Lining | Retrospective review | Single-centre | 2005-2022 | 168 bladder augmentations | Bladder augmentation in the UK has been largely by enterocystoplasty or ureterocystoplasty (UC) | Ileocystoplasty can be simple patch placement (SPP), or formation of an ileal cup (IC) | UC (n = 24) | SPP (n = 72) | IC (n = 72) | Follow-up | 4.23 yrs | 4.43 yrs | 6.2 yrs | Revision surgery required in | 12.5 % | 8.3 % | 0 % | Long-term survival at 10 yrs | 85 % | 75 % | 100 % | Renal stones (seen in imaging) | 0 | 7/56 | 2/62 | Conclusion: Augmentation survival depends on conformation and the presence of suitable mucosa. UC is feasible in only 14% of cases, with IC being preferred over SPP for enterocystoplasty. | https://pubmed.ncbi.nlm.nih.gov/39572279/ | Parkinson E et al. | Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK | Journal of Pediatric Surgery | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's
Long-term Survival of Bladder Augmentation is Influenced by its Shape and Mucosal Lining
Infographic · Apr 2025 · 2 min read
In brief
In brief
This 17-year retrospective study of 168 pediatric bladder augmentations demonstrates that ileal cup configuration achieves superior long-term survival (100% at 10 years) compared to simple patch placement (75% at 10 years), with 6-fold lower rates of stones and revision surgery despite using intestinal mucosa.
- Ileal cup augmentation achieved 100% 10-year survival with zero revision surgeries, outperforming simple patch placement and ureterocystoplasty.
- Simple patch placement had 6.3-fold higher rate of bladder stones and augment failure compared to ileal cup configuration (15.3% vs 2.8%).
- Bladder shape/conformation matters more than mucosal type: ileal cup with intestinal mucosa outperformed simple patch despite same tissue.
- Ureterocystoplasty with urothelial lining is ideal but only feasible in 14% of cases; ileal cup is preferred alternative for enterocystoplasty.
- Stone-free survival at 10 years: ureterocystoplasty 100%, ileal cup 95%, simple patch placement 62% (P=0.028).
Written by the GCMD Library team from the infographic.
The infographic uses a split layout with a light blue left panel showing study details (UK map, retrospective review label) and a teal right panel explaining the three surgical techniques with a bladder illustration. Below, three colored bars (green for UC, pink for SPP, cyan for IC) display comparative outcomes. A yellow conclusion banner spans the bottom, with institutional logos and citation at the base.
Emma Parkinson, Andrew Robb, Liam McCarthy
Introduction: Bladder augmentation in the UK has been largely by enterocystoplasty or ureterocystoplasty (UC). Ileocystoplasty can be simple patch placement (SPP), or formation of an ileal cup (IC). Urothelium is the “right” mucosa, whereas intestinal mucosa exhibits absorption, mucus production, malignancy. On videourodynamics it can be shown that SPP fills with a poor conformation (irregular shape), while IC was good, and UC adequate.
Our aim was to measure the long-term outcomes of augmentation, comparing UC (“right” mucosa and adequate conformation), to SPP (“wrong” mucosa and poor conformation) to IC (“wrong mucosa” and good conformation).
Methods: Single-centre retrospective review. Patients were identified from operative logs for the period 2005 to 2022. Registered as an audit (CARMS 31503). Data collected included: demographics, dates: operation, redo-surgery, imaging, stones (renal/bladder) and any intervention. Data were given as numbers (%), median (range) analysed by Fisher exact test where P < 0.05 was taken as significant.
Results: There were 168 bladder augmentations: UC (n = 24), SPP (n = 72), and IC (n = 72). Follow-up was no different for IC 4.23 (0.05–11.50) vs SPP 4.43 (0.15–13) yrs, but was longer for UC at 6.2 (4.1–8.9) yrs. Age at augmentation was 6.7 (2.5–17.1) vs 8.1 (2–17) vs 11.6 (5.9–17) yrs respectively (UC vs IC vs SPP, P = 0.0001).
Revision surgery was required in 3/24 (12.5 %) UC, 6/72 (8.3 %) SPP, and 0/72 (0 %) IC. IC had fewer redos than SPP, P = 0.028. Long-term survival was significantly better for IC (100 % at 10 years, vs UC 85 % at 10 years and SPP 96 % at 5 yrs and 75 % at 10 yrs, log-rank P < 0.05).
Imaging follow-up was available in SPP (n = 56) IC (n = 62), UC (n = 24) with renal stones identified in 7/56 (%) SPP, 2/62 (%) IC, and 0 in UC. Bladder stones were present in SPP 5/56 (8.9 %) vs IC 2/62 (3.2 %), NS. Stone-free survival was 100 % at 10yrs in UC, 95 % in IC, and 62 % in SPP, P = 0.028.
Combining bladder failure leading to reaugmentation and bladder stones requiring surgery, allows comparison between SPP and IC: In SPP bladder stones and augment failure occurred in 15.3 %, vs 2.8 % in IC. There is a 6.3-fold increase in bladder stones and augment redo with SPP [irregular filling bladder (poor conformation) and the “wrong” mucosa] vs IC (good confirmation, but “wrong” mucosa).
Conclusion: Augmentation survival is influenced by conformation and presence of the “right” mucosa. UC is only possible in 14 % of cases, and an IC is preferable to SPP when an enterocystoplasty is needed.