Long-term Survival of Bladder Augmentation is Influenced by its Shape and Mucosal Lining

Infographic · Apr 2025 · 2 min read

In brief

Retrospective study of 168 bladder augmentations comparing ileal cup, simple patch placement, and ureterocystoplasty techniques over 10 years. Ileal cup configuration showed superior long-term survival (100% at 10 years) and lower revision rates compared to simple patch placement, suggesting bladder shape matters more than mucosal type for augmentation durability.

Ileal cup (IC) augmentation has superior 10-year survival (100%) compared to simple patch placement (75%) or ureterocystoplasty (85%).
Bladder shape matters: IC's good conformation reduces redo surgery (0%) vs simple patch placement (8.3%, p=0.028).
Stone-free survival at 10 years: ureterocystoplasty 100%, ileal cup 95%, simple patch placement 62% (p=0.028).
Simple patch placement has 6.3-fold higher rate of stones and augment failure (15.3%) compared to ileal cup (2.8%).
When enterocystoplasty is needed, ileal cup technique is preferable to simple patch placement despite both using intestinal mucosa.

Written by the GCMD Library team from the infographic.

A clinical comparison infographic displaying three treatment modalities in a side-by-side layout. Each approach is illustrated with anatomical diagrams showing the esophagus and lower esophageal sphincter. Color-coded sections distinguish between procedures, with success percentages prominently displayed. Visual indicators show complication rates and technical requirements for each method.

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.

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