Augmentation Cystoplasty: Fourth-Line Therapy for Refractory Idiopathic Overactive Bladder

Abstract

Objective:

Idiopathic overactive bladder (iOAB) refractory to conventional first-, second-, and third-line therapies is a challenging condition to manage. Fourth-line therapy, specifically urinary diversion or augmentation cystoplasty, has recently been added to the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines for patients who have severe symptoms and are refractory to all other therapies. In this video and short series, we describe the surgical technique and report on contemporary outcomes of augmentation cystoplasty for patients with iOAB.

Methods:

Medical charts of patients undergoing augmentation cystoplasty for iOAB during the years 2012 to 2020 were retrospectively reviewed (n = 8). All patients were followed for at least 6 months with a median of 12 months. Baseline characteristics including patient demographics, preoperative fluorourodynamic parameters, and first-, second-, and third-line iOAB treatments were recorded. Outcomes studied included perioperative outcomes and American Urological Association Symptom Score (AUASS) and Incontinence Symptom Index scores. Wilcoxon signed-rank test was used to assess temporal significance; a two-sided p-value <0.05 was considered significant.

Results:

The median age of the cohort was 54.5 years. All patients were women. The median preoperative bladder compliance was 39.8 cm water and the median preoperative bladder capacity was 134.5 mL. All patients had failed at least two drug regimens and had tried-and-failed either treatment with Botox (37.5%) or InterStim (100%). The median operative time was 6 hours and 10 minutes; the median blood loss was 150 mL. There were significant improvements in patient's AUASS and AUASS-quality of life scores after surgery (p = 0.032 for each).

Conclusions:

As this video and small series demonstrate, for patients who fail to respond to first-, second-, and third-line treatments for iOAB, augmentation cystoplasty may be considered a fourth-line treatment for the most refractory of patients and is associated with statistically improved symptom scores.

None of the authors have any relevant disclosures, and none of the authors have any financial or nonfinancial interests that may be relevant to the submitted article.

Runtime of video: 7 mins 10 secs

This video was presented at the following conferences: SUFU 2020 and AUA NCS 2020.