Title : Changes in bowel habits following Augmentation EnteroCystoplasty (AEC) for neurogenic detrusor overactivity
Abstract:
Background: Augmentation Entero Cystoplasty (AEC) has emerged as a critical intervention for patients with Neurological Lower Urinary Tract Dysfunction (NLUTD), serving as a third-line treatment for neurogenic detrusor overactivity when anticholinergic drugs and botulinum toxin fail, ensuring low-pressure storage and improved continence. However, its effect on bowel function and quality of life remains insufficiently defined. The aim of the current study is to evaluate postoperative changes in bowel function and patient-reported outcomes after AEC in neurological patients, with particular attention to predictors of severe Neurogenic Bowel Dysfunction (NBD).
Methods: This retrospective cohort study included 51 patients who underwent AEC at the University Hospital of Nantes between 2014 and 2024. Clinical data were extracted from medical records, and bowel outcomes were evaluated through postoperative consultations and quantified using the NBD score. Associations between clinical and patient-related variables and bowel dysfunction severity were analyzed.
Results: Of the 51 patients, 41 (80.4%) had spinal cord injury, 3 (5.9%) spina bifida, 1 (1.9%) multiple sclerosis, and 6 (11.8%) other neurological conditions. Hard stools decreased from 33.3% to 13.7% (p=0.001). Severe bowel dysfunction (NBD ≥14) occurred in 47.1% of patients. Accelerated bowel transit was reported by 50.9%, fecal incontinence was infrequent, and gas incontinence affected 60.8%. Complete tetraplegia (OR 11.4, p=0.043) and cholestyramine use (p=0.026) predicted severe dysfunction. Overall, 62.7% of patients remained rather or completely satisfied with the impact of AEC.
Conclusion: AEC improves stool consistency but many patients continue to experience postoperative bowel dysfunction. Individualized bowel management, careful preoperative counseling, and close postoperative follow-up remain essential.
