Complications of enterocystoplasty.

Bladder reconstruction, either by augmentation or substitution enterocystoplasty, is a safe alternative to supravesical urinary diversion providing careful attention to preoperative selection, surgical technique, and postoperative review is observed. However, under the most optimal conditions an untoward outcome may occur. We reviewed our series of 100 intestinocystoplasties to categorize the types of complications encountered, and to identify preoperative risk factors that could potentially develop into an unfavorable sequela. Twenty-seven patients required either early or late surgical intervention, while 30 were managed nonoperatively. In our review we identified two groups, those with myelodysplasia and those with a solitary functioning kidney, who are at a higher risk for an unfavorable outcome to develop.

Management of type III stress urinary incontinence using artificial urinary sphincter.

Type III stress urinary incontinence due to severe intrinsic urethral weakness without significant urethrovesical descensus may be treated by periurethral injection, sling cystourethropexy, bladder neck reconstruction, or artificial urinary sphincter implantation. The rationale for procedure selection depends on a number of patient factors and the surgeon's experience. We herein report on 25 women who were identified as having such incontinence by evaluation which included videourodynamic study and lateral voiding cystography and who were managed by the implantation of an artificial urinary sphincter. The etiology of the severe intrinsic urethral weakness in most patients was multiple prior failed cystourethropexies. Postoperatively, 1 patient died of a cerebral vascular accident. The remaining 24 women had significantly improved continence and were completely satisfied at latest follow-up. No revisions have been required for patients receiving an artificial sphincter after 1983. No sphincter erosions or infections have occurred. Our experience and review of the literature shows that the artificial sphincter provides an excellent first option for women with type III urinary stress incontinence due to intrinsic urethral weakness of various etiologies.