LAUSR

The technique of seromuscular bladder augmentation (SMBA), as first described experimentally by Shoemaker [1] and later popularized in human subjects by Dewan [2], continues to hold great interest among urologists as a means of providing an augmentation substrate that avoids incorporation of absorptive epithelium. Yet the widespread acceptance of this technique has remained elusive, due to lack of evidence that a significant decrease in complication rate exists that would warrant the increased technical challenges and length of the operative procedure. To this end, the authors of the present paper seek to document differences between augmentation with unaltered ileal and demucosalized colonic segments. While this report lends further support to SMBA being a safe and effective technique, the results presented show no advantage over standard enterocystoplasty. The small number of subjects in the SMBA group (n Z 10) does not provide sufficient power to demonstrate a statistically significant difference in the categories investigated. The authors point to more stones being formed in the ileocystoplasty group (8/30 or 27%) relative to the SMBA cohort. However, from the results section, one gleans that only five of the stones were of significant size to require surgical intervention. If only 5/30 (17%) patients had significant stones, the calculated P-value between the SMBA and ileocystoplasty groups would be PZ 0.17. Compared to the historical results of Jednak, et al, who found that 6% of his cohort of 32 SMBA patients developed calculi [3], the