Purpose: Catheter obstruction from mucus plugging and urinary leakage are common problems after enterocystoplasty. A large suprapubic catheter and frequent bladder irrigation with normal saline are routinely used in the postoperative period to decrease catheter plugging. In this study we evaluated the use of a somatostatin analogue (Sandostatin to decrease mucus production by the intestinal segment after enterocystoplasty.
Materials and methods: We performed enterocystoplasty using ileal segments (20 to 30 cm) in 40 patients. In 20 patients Sandostatin (0.05 mg subcutaneously) was started 1 hour before the procedure and was then administered every 8 hours for 15 days. Bladder irrigation was performed whenever drainage from the suprapubic catheter caused blockage. The drain was removed 24 to 48 hours after the resumption of oral feeding if urine leakage was insignificant. We then compared the number of bladder irrigations required, mucus volume, time to remove the drain and hospital stay between the groups.
Results: Only 5 patients in the treatment group required bladder irrigation. The mean number of bladder irrigations for each patient was 0.35 +/- 0.67 in the group receiving Sandostatin and 10.35 +/- 2.13 for the control group (p <0.001). Mean mucus volumes on postoperative day 3 were 4.42 +/- 1.95 and 42.5 +/- 5.14 ml in the treatment and control groups, respectively (p <0.001). Mean time to remove the drain was 6.35 days for the Sandostatin group and 6.8 days for the control group. Mean hospital stay was 7.4 and 7.9 days for the treatment and control groups, respectively (p <0.05).
Conclusions: Sandostatin caused a marked decrease in mucus production by the intestinal segment with patients receiving Sandostatin no longer requiring routine postoperative bladder irrigation and having a shorter hospital stay.