SUCCESS AND FAILURE OF SEROMUSCULAR COLOCYSTOPLASTY 1785

EDITORIAL COMMENTS

The information provided in this article is of limitedvalue. The authors used the technique that we orig-inally described1 with the difference that dissectionof the intestinal mucosa was done from inside, whichin my view is the main reason for the poor resultsobtained. In our prospective study of 205 patients 60had a continent catheterizable channel, including anantegrade colonic enema in 20 and a Mitrofanoff

REFERENCE

Urinary Reconstruction-Scandinavian Journal of Urology and Nephrology Supplement.

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REFERENCES

planted. Compared with subgroups in the same se-ries in which these conditions were not present nodifference was found. The discussion reflects wellthe experience of the senior author.

Salvador Vilar C. Lima

Department of Surgery/UrologyFederal University of Pernambuco

channel in 40, and 50 had an artificial device im- Recife, Brazil

1. Lima SVC, Araujo LAP and Cavalcanti FJ: Nonsecretory sigmoidocystoplasty (vídeo). In: Continent Urinary Reconstruction, 1992, Lund-Suecia. Proceedings of Continent

Stockholm: Universitetsforlaget 1992; vol 142, p 187.

These authors present a summary of a case seriesoutlining clinical outcomes and the technical fea-tures of a methodology of bladder augmentation thathas been championed by the senior author. Theyacknowledge some of the limitations of the series,including the small number, but add useful informa-tion on the technical details for any readers whomay wish to pursue this technique as a means ofachieving continence and enhanced bladder capacityin patients with neurogenic bladder. The study pre-sents data in contemporary fashion with urody-namic data and bladder capacity shown as an ageappropriate percent of expected capacity. The com-plications are described and the authors have drawn

that certain concurrent procedures not be includedwith SCLU.

This technique is unique in avoiding the incorpo-ration of bowel mucosa into the urinary tract. Assuch, it may be a compelling alternative for thosewho view the risk of malignancy as a major riskfactor in bladder augmentation cases. As presentedin this study, the data provide a potentially valuabletemplate to others who may wish to pursue thistechnique in a multicenter, prospective trial.

Gordon A. McLorie

Division of Pediatric UrologyWake Forest University School of Medicine

Wake Forest University Baptist Medical Center

conclusions applicable to the technique, suggesting Winston Salem, North Carolina

We published the first experimental results withthis operation in 1994.1 The 1992 reference cited inthe editorial comment does not appear in PubMed®and we were unaware of it. In 1995 Lima et alreported experimental and clinical data on 10 pa-tients with a mean followup of 23 months.2 Theysubsequently changed the technique to one that does

to maintain initial bladder distension (reference 8 inarticle). Of 183 patients a third failed to achieve aBC greater than 200 ml. Also intriguing is how aMitrofanoff channel was constructed since the blad-der mucosa was not preserved. We disagree that ourresults are poor as a comparison of our data speaksfor itself. Finally, we welcome the proposal for a

not preserve the urothelium and requires a balloon prospective multicenter study.

1. Buson H, Manivel JC, Long R et al: Seromuscular colocystoplasty lined with urothelium (SCLU): experimental study. Urology 1994; 44: 743.

2. Lima SVC, Araojo LAP, Vilar FO et al: Nonsecretory sigmoid cystoplasty: experimental and clinical results. J Urol 1995; 153: 1651.