[Bladder augmentation in reconstruction of the urinary tract (1985-1997)]

Bladder augmentation with intestinal or urinary segments has virtually replaced other treatments in the management of both neuropathic and no neuropathic bladder dysfunction that has not responded to pharmacotherapy nor other intervention. We present herein our experience in 55 patients who underwent augmentation cystoplasty. Their mean age were 12.2 years (range 2.5-22.8) and the mean follow-up time was 4 years (1-13.1). They were divided in three groups according to the diagnosis: vesical or cloacal exstrophy (14 patients), neuropathic bladder (36) and posterior urethral valves (5 patients). Indications were: 1) to get a low pressure, high volume reservoir and avoid upper urinary tract damage in low-compliance bladders (41 patients); 2) as an undiversion (8 patients), and 3) prior to renal transplantation. Cystoplasty was performed with bowel segments in 47 cases and ureter in 8, adding some other urological procedures in 22 patients. Mean bladder capacity after 1 year was 400 ml versus 112 as previous value. 52 out of the 55 patients are continent after augmentation. There was no impairment of the renal function in the 5 patients with prior renal failure who underwent cystoplasty. Vesicoureteral reflux disappeared in 78.6% of the patients after cystoplasty. The complications were urinary stones in 5 cases, upper urinary tract infections in 3, and spontaneous bladder perforation in 1 patient. Augmentation cystoplasty is the best choice to achieve a low pressure reservoir, to assure contingency and to avoid progressive damage of the upper urinary tract in neuropathic or no neuropathic pediatric bladder dysfunctions.