RECONSTRUCTED BLADDER FUNCTION AND DYSFUNCTION (L WESTNEY, SECTION EDITOR) Functional Outcomes of Augmentation Cystoplasty in the non-Neurogenic Patient Anne M. Suskind & John T. Stoffel Published online: 7 September 2013 # Springer Science+Business Media New York 2013 Abstract Augmentation cystoplasty is a procedure that is used to improve bladder capacity and compliance. While most commonly performed in patients with neurogenic conditions, this procedure can also be performed in selected patients with non-neurogenic conditions with good success. For example, augmentation cystoplasty has been reported in patients with refractory overactive bladder, end-stage bladders requiring renal transplantation, and infectious and inflammatory disor- ders such as interstitial cystitis/bladder pain syndrome. Ad- vances in surgical techniques and bioengineering research continue to improve surgical outcomes and move the proce- dure in exciting new directions. Keywords Enterocystoplasty . Bladder augmentation . Refractory overactive bladder . Transplantation . Tuberculosis . Schistosomiasis . Interstitial cystitis . Bladder pain syndrome . Autoaugmentation . Tissue engineering Introduction The first augmentation cystoplasty was performed in a canine model 1888 by Tizzoni and Foggi [1], and was soon replicated in humans in 1889 by Mikulicz [2]. However; it wasn’t until the 1950s that the technique was popularized by Couvelaire as a treatment for bladders contracted by genitourinary tubercu- losis (TB) [3]. Later, with the introduction of clean intermit- tent catheterization, augmentation cystoplasty became more widely used for a variety of indications. Over time, several different tissues have been trialed for use in this procedure, including bowel segments, stomach, peritoneum, omentum, lyophilized human dura, skin, pericardium, placenta, fascial grafts, and even the gallbladder [4–6]. Although the standard of care remains intestinal segments, the search for the ideal material for use in augmentation cystoplasty continues with advances in cell biology and tissue engineering. Augmentation cystoplasty is most commonly used in cases related to neurogenic patients; however, there are several indi- cations for this procedure among non-neurogenic patients as well. Any refractory condition that leads to problems with bladder safety during the filling and storage phases of micturi- tion, i.e., resulting in low bladder capacity and poor bladder compliance, can potentially be mitigated by augmentation cystoplasty. These conditions include refractory overactive bladder, end-stage bladders leading to renal transplantation, infectious and inflammatory disorders that involve the bladder, and history of pelvic radiation and lower urinary tract surgery. Refractory OAB The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Re- construction (SUFU) recommend augmentation cystoplasty only for the treatment of rare cases of refractory overactive bladder. This recommendation is based on expert opinion and clearly states that there are substantial risks associated with this procedure, including the likelihood for the need for long-term catheterization and the risk of malignancy [7••]. Bladder aug- mentation serves to increase bladder capacity and maintain low detrusor pressure (or good compliance) during bladder filling and storage, which may be compromised in patients with severe overactive bladder. Due to advances in behavioral therapy, pharmacotherapy, sacral nerve neuromodulation, percutaneous A. M. Suskind : J. T. Stoffel (*) Division of Neurourology & Pelvic Reconstructive Surgery, Department of Urology, A. Alfred Taubman Health Care Center, University of Michigan, 1500 E. Medical Center Dr, SPC 5330, Ann Arbor, MI 48109, USA e-mail: jstoffel@med.umich.edu A. M. Suskind e-mail: suskina@med.umich.edu Curr Bladder Dysfunct Rep (2013) 8:336–343 DOI 10.1007/s11884-013-0205-8