Opportunities for augmentation cystoplasty revision without additional bowel harvest: “Hourglass” deformity or non-detubularized augment

Introduction: We describe our experience performing bladder augmentation revision without additional bowel harvest for certain suboptimal cystoplasty configurations. Methods: We identified patients with prior bladder augmentation who underwent augmentation revision without additional bowel harvest at our institution. These patients were identified to have either “hourglass” deformity or non-detubularized augment previously. Revision was performed using an open technique by detaching the prior augment and performing detubularization and/ or completion cystotomy as needed. Baseline characteri0stics, perioperative courses, and followup information were reviewed. Pre- and postoperative cystography and urodynamics were assessed. Results: Seven patients underwent bladder augmentation revision without the use of additional bowel. Three patients were found to have a non-detubularized augment, while the other four had a narrow connection from the native bladder to augment. Cystography demonstrated correction of “hourglass” deformity for the four patients, and urodynamics revealed resolution of phasic contractions after detubularization. Six of seven patients reported significant improvements in symptoms, such as frequency, urgency, and incontinence. One patient ultimately required Indiana pouch urinary diversion. All patients are performing intermittent catheterization at last followup. Conclusions: Patients with a prior bladder augmentation with inadequate urine storage should have testing to identify the possibility of a non-detubularized augment or “hourglass” deformity. These patients can be safely offered a revision without the need for additional bowel harvest.