Long‐term outcomes of augmentation cystoplasty for neurogenic lower urinary tract dysfunction after spinal cord injury

Abstract

Objective To evaluate long‐term urodynamic, clinical, and complication outcomes following augmentation cystoplasty (AC) in patients with spinal cord injury (SCI) and refractory neurogenic lower urinary tract dysfunction (NLUTD), and to assess the role of adjunctive intradetrusor onabotulinumtoxinA injections. Patients and Methods We performed a retrospective cohort study of patients with SCI undergoing AC at a tertiary referral centre between 1988 and 2018. Inclusion required refractory NLUTD with documented urodynamic abnormalities and failure of conservative and minimally invasive therapies. Pre‐ and postoperative outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), continence status, recurrent urinary tract infections (rUTIs), vesico‐ureteric reflux (VUR), and complications. A subgroup analysis evaluated outcomes following post‐augmentation intradetrusor onabotulinumtoxinA injections. Statistical comparisons were performed using paired t ‐tests. Results A total of 70 patients (47 male, 23 female) were included, with a mean (range) follow‐up of 19 (5–36) years. AC resulted in significant improvements in MCC (155–490 mL; P < 0.001) and MDP (72–19 cmH 2 O; P < 0.001). Continence was achieved in 67% of patients, with a further 24% reporting only occasional leakage. rUTIs and antimuscarinic use decreased postoperatively, and VUR improved in most affected patients. Long‐term complications included urolithiasis in 10%, malignancy in 4% (all adenocarcinoma), and spontaneous perforation in 1.5%. In patients requiring adjunctive botulinum toxin ( n = 18), significant improvements in MCC and MDP were observed in selected analyses ( P = 0.025 and P = 0.009, respectively). Conclusion Augmentation cystoplasty provides durable long‐term improvements in bladder capacity, storage pressures, and continence in patients with SCI with refractory NLUTD, with sustained protection of the upper urinary tract. Although associated with notable late complications, outcomes remain favourable with structured lifelong surveillance. Adjunctive intradetrusor onabotulinumtoxinA injections offers additional benefit in a subset of patients and may optimise long‐term bladder dynamics.