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Outcome of augmentation sigmoidocystoplasty in children with neurogenic bladder
N Arikan1, K Türkölmez, M Budak
1Department of Urology, University of Ankara, School of Medicine, Ankara, Turkey.
Insights
Sigmoid augmentation cystoplasty effectively manages neuropathic bladder in children, improving continence and protecting kidneys when conservative treatments fail. Clean intermittent self-catheterization (CISC) is key to this success.
Area of Science:
- Pediatric Urology
- Surgical Gastroenterology
Background:
- Neuropathic bladder significantly impacts voiding dysfunction in children.
- Clean intermittent self-catheterization (CISC) is a recognized treatment for voiding dysfunction.
Purpose of the Study:
- To evaluate the clinical outcomes of sigmoid augmentation cystoplasty in pediatric patients with neurogenic bladder.
- To assess the efficacy of this surgical approach in managing refractory voiding dysfunction.
Main Methods:
- Eighteen children (ages 5-17) underwent sigmoid augmentation cystoplasty using a modified clam technique between 1991 and 1997.
- Ureteroneocystostomy was performed in 4 cases; follow-up ranged from 16 to 70 months.
Main Results:
- 83% of patients achieved continence with CISC, maintaining low detrusor pressure.
- Pyuria was observed in 10 cases, with 2 symptomatic. One case of clinical acidosis was noted.
Conclusions:
- Augmentation cystoplasty combined with CISC is an effective treatment for pediatric neurogenic bladder.
- This approach successfully protects the upper urinary tract and prevents incontinence in children unresponsive to conservative management.
Purpose:
The role of augmentation cystoplasty in the neuropathic bladder has been well determined since clean intermittent self-catheterization (CISC) has been accepted as a treatment modality in voiding dysfunction. We present our clinical experience with sigmoid augmentation cystoplasty in children with neurogenic bladder disorder.
Material And Methods:
From 1991 to 1997 sigmoid augmentation cystoplasty with modified clam technique was performed in 18 cases with neuropathic bladder pathologies. In 4 cases, ureteroneocystostomy was performed, 2 of whom were bilateral. Age range of these patients was 5-17 years (mean 10.3 years) and follow-up period was from 16 to 70 months (mean 41 months).
Results:
Pyuria was detected in 10 cases and 2 of them were symptomatic. Clinical acidosis was detected in only 1 case. Fifteen cases (83%) were continent by using CISC with 4-6 hourly and detrusor pressure lower than 30 cm water at maximal bladder capacity.
Conclusion:
In children with neurogenic bladder pathologies refractory to conservative management, augmentation cystoplasty with CISC is an effective treatment modality in protecting the upper urinary tract and preventing incontinence.