The "clam": indications and complications.

We have reviewed 78 patients who underwent "clam" enterocystoplasty as part or all of their lower urinary tract reconstruction. Nearly half (32) were non-neuropathic; the remainder were either overtly neuropathic (mainly spina bifida) or suspected neuropathic (mainly the older primary enuretics). Only 5 were non-walkers--all neuropathic. Most patients were operated on for incontinence but 12 had upper tract damage related either to urinary diversion or to poor bladder compliance in the early phase of filling; 69 patients became dry, voiding spontaneously (30), by activation of an artificial urinary sphincter (17) or by self intermittent catheterisation (22). Four patients still have nocturnal enuresis, 3 diurnal enuresis and 2 have stress incontinence. One patient has had a continent diversion. The "clam" procedure has revolutionised bladder reconstruction. Careful review has failed to predict the small number who do not achieve a perfect result.