The clam enterocystoplasty in the treatment of idiopathic detrusor instability

Enterocystoplasty is being used increasingly frequently in the treatment of both idiopathic detrusor instability and neuropathic bladder dysfunction. After operation, most patients with idiopathic detrusor instability and disabling urinary incontinence refractory to previous treatments, experience improvements in continence and urgency, but residual symptoms are common. Detrusor instability can be demonstrated in over half of patients after operation, but significant decreases in the severity of instability are found after operation as assessed by the volume at first unstable contraction. Enterocystoplasty is a major operation with the potential for postoperative morbidity and mortality. In addition, the improvements in symptoms are bought at a price: increases in residual urine are common, and in the long term many patients need to perform clean intermittent self-catheterization, and some experience recurrent urinary infections. Patients about to undergo enterocystoplasty should be carefully selected and should be trained in the use of CISC. In selected patients with severe refractory idiopathic detrusor instability, the procedure can yield satisfactory results.