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Sigmoid Cystoplasty (Sigmoidocystoplasty)

Sigmoid cystoplasty is a form of augmentation cystoplasty that uses a detubularized segment of sigmoid colon to enlarge the bladder. It can improve capacity and compliance, with practical advantages including pelvic proximity and a thick wall for selected ureteral implantation. A retrospective comparison found a trend toward less small-bowel obstruction (SBO) than ileal augmentation; this did not establish comparative superiority.[1][2] The cited center favored sigmoid; segment selection remains individualized rather than a universal preference.[1]

Indications​

Same as for other forms of augmentation cystoplasty — refractory low-compliance or overactive bladder. Common underlying conditions: neurogenic bladder, exstrophy, posterior urethral valves, refractory IC/BPS.[1][3][4]

Sigmoid is particularly favored when:

  • Ureteral reimplantation is needed — thick sigmoid wall provides an excellent submucosal tunnel.[3][5]
  • Bowel anatomy or prior surgery favors colon. Improvement in constipation was reported in one selected series; constipation alone is not an established indication to choose a sigmoid augment.[4]
  • Preserving small bowel is desirable; colonic surgery still carries bowel obstruction and anastomotic risks.[1]
  • A Mitrofanoff channel is planned — the sigmoid "tail" modification can stabilize the catheterizable stoma.[5]

Surgical Technique (Goodwin cup-patch)​

  1. Segment isolation: ~15–25 cm of sigmoid on its mesentery, preserving the marginal artery.
  2. Bowel continuity restoration: end-to-end or side-to-side colocolonic anastomosis.
  3. Detubularization: opened along the antimesenteric border. In an older small comparison, volume-dependent contractions persisted in 15/16 tubular sigmoid versus 1/8 sigmoid cup-patch patients at mean 19.4-month follow-up. These are selected cohort results, not guaranteed rates.[6][2]
  4. Reconfiguration: folded into a U-shaped or cup-patch configuration (Laplace's law).
  5. Cystotomy: native bladder bivalved.
  6. Anastomosis: sigmoid patch sutured to the opened bladder watertight.[6][7]

Sigmoid "tail" modification: A 3–5 cm segment of non-detubularized colon is left intact and fixed to the posterior abdominal wall to stabilize a catheterizable stoma (appendix or tapered ileum).[5]

Concomitant ureteral reimplantation, outlet surgery, or a catheterizable channel may be appropriate for specific anatomy and function. Reported reimplantation frequencies reflect selected cohorts, not a requirement for all reflux.[1][3][5][8][9]

Outcomes​

Study / populationReported outcomeInterpretation
Zhang 2012, 47 patients, mean 24 monthsMean capacity 160.6 → 468.5 mL; maximal detrusor pressure 31.1 → 10.9 cm H₂ORetrospective; selected concomitant reimplantation[3]
Zhang 2014, 52 patients, mean 49 monthsSafe capacity 113.8 → 373.1 mL; compliance 2.96 → 14.07 mL/cm H₂ORetrospective; not a direct ileal comparison[4]
Hayashi 2006, 86 patients, mean 13.1 yearsNormal creatinine clearance in 80/86; continence score improved in 61/86Improvement is not the same as complete dryness; eight patients had increased renal scarring[8]

In an 86-patient long-term series (Hayashi 2006, n=86, mean follow-up 13.1 yr), CrCl was normal in 93% and continence improved in 71%; bladder stones occurred in 21% but were absent at final review.[8] Zhang 2014 (n=52, mean 49 mo) reported significant improvements in capacity, compliance, and renal function with all 52 reporting satisfaction and improved constipation; no overt acidosis or perforation was observed. These uncontrolled findings do not establish comparative benefit or zero long-term risk.[4]

Sigmoid vs. Ileum​

FeatureSigmoidIleum
Bowel obstructionLess small-bowel handling; lower-SBO trend in one retrospective comparisonBowel handling and adhesions remain relevant
Anatomic proximity to bladderCloserRequires mobilization
Ureteral reimplantationThick wall — reliable submucosal tunnelThinner wall
Ileocecal valvePreservedPreserved
Bowel functionImprovement in constipation reported in one selected cohortBowel effects vary with segment, length, and baseline disease
Pathologic contractions (long-term)43%26%
Mucus productionClinically relevant mucus burdenClinically relevant mucus burden; no dependable rank from these sources

The key disadvantage: a higher rate of persistent pathologic contractions — 43% with colocystoplasty vs 26% with ileocystoplasty in a long-term urodynamic study of 84 patients. All groups improved; the nonrandomized comparison does not establish the best segment for every patient.[10]

Complications​

  • Persistent reservoir contractions — also occur with ileum and stomach. The 12%, 43%, and 26% figures above come from different cohorts and configurations and should not be combined into a treatment-effect range. Zhang’s 52-patient sigmoid series required anticholinergics in 6/52 (11.5%).[2][4][6][10]
  • Urinary tract stones: ~21% (18/86) in the largest long-term series; risk factors include continent stomas and exstrophy.[1][8]
  • Recurrent febrile UTIs: ~21%.[4]
  • Bowel dysfunction: ~10.6%; sigmoid resection may paradoxically improve constipation in neurogenic bowel.[3][4]
  • Adhesive intestinal obstruction: ~8.5%; overall SBO rate trends lower than with ileocystoplasty.[1][3]
  • Bladder perforation: comparable to ileocystoplasty; highest risk in neurogenic bladder.[1]
  • Vesicoureteral reflux: Hayashi reported low-grade recurrence in 6/58 renal units reimplanted during augmentation (in five patients), and grade I reflux in two of 44 patients without reimplantation. These are different denominators and not a randomized comparison.[8]
  • Deteriorating renal function: 5.2–6.4%.[3][9]

Metabolic Disturbances​

  • Animal-model data: no metabolic advantage of ileum over colon — both cause comparable acidosis.[11]
  • Pediatric series: significant hyperchloremic acidosis in 10%, borderline acidosis in 27% after sigmoidocystoplasty.[12]
  • Calcium / phosphorus abnormalities in 16.5% / 43%, more frequent in acidotic patients — likely reflecting bony buffer activation; may delay growth in children.[12]
  • Clinically significant acidosis primarily in patients with pre-existing renal insufficiency.[2]
  • Zhang 2014 reported no obvious metabolic acidosis at mean 49 mo.[4]

Treat documented acidosis with individualized alkali therapy and dependable emptying. Potassium-containing alkali requires caution in renal impairment or hyperkalemia.

Histopathology and Malignancy Risk​

Long-term histopathology of sigmoidocystoplasty:[8][13]

  • Inflammation in all cases at >10-yr follow-up.
  • Hyperplasia ~10%; metaplasia ~5%.
  • No malignancy was reported in these follow-up cohorts; their size, duration, biopsy selection, and possible cohort overlap prevent a conclusion of zero lifetime risk.
  • PCNA staining was significantly more intense in patients who stopped regular bladder irrigations and in those with bladder stones, suggesting these factors may promote mucosal proliferation.

Overall malignancy risk after augmentation:[14][15][16]

  • Urothelial cell carcinoma is the most common histologic type after colocystoplasty (vs adenocarcinoma after gastrocystoplasty).
  • A retrospective German survey reported tumors in 1.58% of cystoplasties versus 0.05% of ileal neobladders and 0.02% of ileal conduits. These are crude reported proportions across different diseases and follow-up periods, not adjusted comparative or sigmoid-specific lifetime risks.
  • Mean latency ~19–20 yr; tumors frequently advanced at diagnosis with poor prognosis (1-yr survival ~56%).
  • Older reports recommended endoscopy from five years; current AUA/SUFU guidance favors symptom-triggered evaluation in stable NLUTD. Gross hematuria, recurrent unexplained symptomatic UTI, or suprapubic pain warrant investigation without waiting for an anniversary.[23][15][17]

Seromuscular Colocystoplasty Lined With Urothelium (SCLU)​

A notable variant designed to avoid incorporating intestinal mucosa into the urinary tract:[18][19]

  1. A de-epithelialized (mucosa-stripped) sigmoid seromuscular patch is prepared, preserving the submucosa (critical to prevent patch contraction and fibrosis).[19]
  2. Native bladder urothelium is exposed by detrusorectomy at the dome.
  3. The seromuscular patch is placed over the exposed urothelium, which then lines the augmented segment.

SCLU outcomes[20][21][22]​

  • Capacity ↑ 1.8–2.96-fold.
  • These small series reported no perforations, bowel obstruction, or metabolic abnormalities during their follow-up; this does not establish zero risk.
  • Mucus production not clinically significant.
  • Continence achieved in 71–81% after initial/secondary procedures.
  • Hourglass deformity in 22%; augmentation failure in 12.5%.
  • Biopsy shows colonic mucosal regrowth in some patients (5/7 interpretable biopsies in one series).
  • One 20-patient study advised against a simultaneous catheterizable channel after 3/5 such patients required reaugmentation; this limited observation is specific to SCLU and does not make a channel a contraindication to conventional augmentation or pure autoaugmentation.[22]
  • Selected SCLU series combined it with an AUS. They do not establish AUS as universally necessary or superior; storage safety and an effective emptying route remain essential.

Long-Term Follow-Up​

Per the AUA/SUFU NLUTD guideline, annual lifelong surveillance:[23]

  • Focused history, exam, symptoms.
  • Basic metabolic panel (electrolytes, bicarbonate, renal function).
  • Renal ultrasound for hydronephrosis and stones.
  • Regular bladder irrigations to reduce mucus accumulation and stone formation.[13]
  • Cystoscopy for concerning symptoms, rather than an automatic five-year screening start; see the guideline-based surveillance discussion above.[15][17]
  • Monitoring for calcium / phosphorus abnormalities and bone health, particularly in children.[12]

Sigmoid vs. Ileum — When to Choose Sigmoid​

Sigmoid cystoplasty is particularly well suited when:[1][4][5][6]

  • Ureteral reimplantation is needed (thick wall for submucosal tunnel).
  • Bowel assessment and available anatomy favor using colon.
  • Preserving small bowel is important, while accepting colonic surgical risks.
  • The ileocecal valve and terminal ileum should be preserved (B₁₂ or bile-salt malabsorption risk).
  • SCLU is planned (sigmoid is the standard segment for this technique).

Primary disadvantage: higher rate of pathologic contractions vs ileum — making detubularization and cup-patch reconfiguration essential.[6][10]

References​

1. Shekarriz B, Upadhyay J, Demirbilek S, Barthold JS, González R. "Surgical Complications of Bladder Augmentation: Comparison Between Various Enterocystoplasties in 133 Patients." Urology. 2000;55(1):123-8. doi:10.1016/s0090-4295(99)00443-4

2. Mitchell ME, Piser JA. "Intestinocystoplasty and Total Bladder Replacement in Children and Young Adults: Followup in 129 Cases." The Journal of Urology. 1987;138(3):579-84. doi:10.1016/s0022-5347(17)43264-2

3. Zhang F, Liao L. "Sigmoidocolocystoplasty With Ureteral Reimplantation for Treatment of Neurogenic Bladder." Urology. 2012;80(2):440-5. doi:10.1016/j.urology.2012.05.010

4. Zhang P, Yang Y, Wu ZJ, et al. "Long-Term Follow-Up of Sigmoid Bladder Augmentation for Low-Compliance Neurogenic Bladder." Urology. 2014;84(3):697-701. doi:10.1016/j.urology.2014.05.025

5. Mathews R, Docimo S, Gearhart JP. "Sigmoid 'Tail' Modification for Bladder Augmentation." Urology. 1997;49(4):609-11. doi:10.1016/s0090-4295(97)00006-x

6. Sidi AA, Reinberg Y, Gonzalez R. "Influence of Intestinal Segment and Configuration on the Outcome of Augmentation Enterocystoplasty." The Journal of Urology. 1986;136(6):1201-4. doi:10.1016/s0022-5347(17)45282-7

7. Reddy PK, Lange PH, Fraley EE. "Total Bladder Replacement Using Detubularized Sigmoid Colon: Technique and Results." The Journal of Urology. 1991;145(1):51-5. doi:10.1016/s0022-5347(17)38245-9

8. Hayashi Y, Yamataka A, Kaneyama K, et al. "Review of 86 Patients With Myelodysplasia and Neurogenic Bladder Who Underwent Sigmoidocolocystoplasty and Were Followed More Than 10 Years." The Journal of Urology. 2006;176(4 Pt 2):1806-9. doi:10.1016/j.juro.2006.03.123

9. Wang Z, Liao L. "Effectiveness and Complications of Augmentation Cystoplasty With or Without Nonrefluxing Ureteral Reimplantation in Patients With Bladder Dysfunction: A Single Center 11-Year Experience." The Journal of Urology. 2018;199(1):200-205. doi:10.1016/j.juro.2017.07.073

10. Juhász ZS, Kispál Z, Kardos D, Vajda P. "Long-Term Urodynamic Findings Following Colo-, Gastro- And Ileocystoplasty." Pediatric Surgery International. 2024;40(1):131. doi:10.1007/s00383-024-05714-z

11. Mohler JL. "Metabolic Acidosis After Bladder Replacement: Comparison of Severity and Reversibility in Ileal and Colonic Reservoirs." The Journal of Urology. 1988;139(3):628-33. doi:10.1016/s0022-5347(17)42547-x

12. Beseghi U, Guys JM, Dibenedetto V, et al. "Metabolic Consequences of Sigmoidocystoplasty in Children." Pediatric Surgery International. 1996;11(2-3):150-2. doi:10.1007/BF00183750

13. Miyano T, Yamataka A, Iwashita K, et al. "Histology of the Neobladder Mucosa After Sigmoidocolocystoplasty." Journal of Pediatric Surgery. 2000;35(1):104-8. doi:10.1016/s0022-3468(00)80024-x

14. Garnier S, Vendrell J, Boillot B, et al. "Malignancy After Augmentation Enterocystoplasty: A Nationwide Study of Natural History, Prognosis and Oncogene Panel Analysis." The Journal of Urology. 2020;204(1):136-143. doi:10.1097/JU.0000000000000752

15. Kälble T, Hofmann I, Riedmiller H, Vergho D. "Tumor Growth in Urinary Diversion: A Multicenter Analysis." European Urology. 2011;60(5):1081-6. doi:10.1016/j.eururo.2011.07.006

16. Biardeau X, Chartier-Kastler E, Rouprêt M, Phé V. "Risk of Malignancy After Augmentation Cystoplasty: A Systematic Review." Neurourology and Urodynamics. 2016;35(6):675-82. doi:10.1002/nau.22775

17. Austen M, Kälble T. "Secondary Malignancies in Different Forms of Urinary Diversion Using Isolated Gut." The Journal of Urology. 2004;172(3):831-8. doi:10.1097/01.ju.0000134890.07434.8e

18. Gonzalez R, Buson H, Reid C, Reinberg Y. "Seromuscular Colocystoplasty Lined With Urothelium: Experience With 16 Patients." Urology. 1995;45(1):124-9. doi:10.1016/s0090-4295(95)97364-8

19. Buson H, Manivel JC, Dayanç M, Long R, Gonzalez R. "Seromuscular Colocystoplasty Lined With Urothelium: Experimental Study." Urology. 1994;44(5):743-8. doi:10.1016/s0090-4295(94)80220-3

20. Jung HJ, Lee H, Im YJ, et al. "Prerequisite for Successful Surgical Outcome in Urothelium Lined Seromuscular Colocystoplasty." The Journal of Urology. 2012;187(4):1416-21. doi:10.1016/j.juro.2011.12.009

21. Jednak R, Schimke CM, Barroso U Jr, Barthold JS, González R. "Further Experience With Seromuscular Colocystoplasty Lined With Urothelium." The Journal of Urology. 2000;164(6):2045-9.

22. González R, Ludwikowski B, Horst M. "Determinants of Success and Failure of Seromuscular Colocystoplasty Lined With Urothelium." The Journal of Urology. 2009;182(4 Suppl):1781-4. doi:10.1016/j.juro.2009.02.062

23. Ginsberg DA, Boone TB, Cameron AP, et al. "The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-Up." The Journal of Urology. 2021;206(5):1106-1113. doi:10.1097/JU.0000000000002239