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Published on: August 9, 2012
A new approach to bladder augmentation in children: seromuscular enterocystoplasty
1Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey.
Insights
Seromuscular enterocystoplasty (SE) combined with detrusorectomy effectively augments bladder capacity and reduces intravesical pressure in children with spastic neurogenic bladder. This procedure offers a viable solution for managing complex bladder conditions in pediatric patients.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Urology
Background:
- Spastic neurogenic bladder in children, often due to spinal trauma, presents challenges with incontinence and low bladder capacity.
- Conventional treatments like anticholinergic medication and clean intermittent catheterization may not adequately manage severe cases.
Purpose of the Study:
- To evaluate the efficacy of seromuscular enterocystoplasty (SE) combined with detrusorectomy in pediatric patients.
- To assess the impact of this combined surgical approach on bladder capacity and intravesical pressure.
Main Methods:
- Seromuscular enterocystoplasty (SE) combined with detrusorectomy was performed on 10 children (aged 10-17) with spastic neurogenic bladder.
- Patients were evaluated for pre- and post-operative bladder capacity and end-filling intravesical pressure.
Main Results:
- Mean bladder capacity significantly increased from 82.9 mL to 319.6 mL post-surgery.
- Mean end-filling intravesical pressure decreased from 47.7 cmH2O to 21.1 cmH2O.
- 9 out of 10 patients achieved successful voiding without incontinence; one required clean intermittent catheterization due to urinary retention.
Conclusions:
- Seromuscular enterocystoplasty (SE) with detrusorectomy is an effective method for bladder augmentation in children.
- The procedure provides desirable features for an ideal augmentation segment, improving bladder function and continence.
Objective:
To report the use of seromuscular enterocystoplasty (SE) combined with detrusorectomy, in children.
Patients And Methods:
Between 1993 and 1998, SE was performed in 10 children (aged 10-17 years) with a spastic neurogenic bladder resulting from spinal trauma. Before surgery all children were incontinent and despite anticholinergic medication and clean intermittent catheterization, their bladder capacity was 60-100 mL and their intravesical pressure 40-60 cmH2O.
Results:
Before surgery, the mean end-filling intravesical pressure was 47.7 cmH2O and the mean bladder capacity 82.9 mL. At 3 months after surgery the mean end-filling intravesical pressure was decreased to 21.1 cmH2O and the mean bladder capacity increased to 319.6 mL. One patient (a 14-year-old girl) had urinary retention soon after surgery and has since used clean intermittent catheterization. The other children were able to void successfully using the Valsalva manoeuvre; none were incontinent. All patients were followed and there were no changes in intravesical pressure and bladder capacity.
Conclusion:
In providing most of the desired features of an ideal augmentation segment, SE is a good and effective method of bladder augmentation.
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