Augmentation ureterocystoplasty in bladder exstrophy: 5-year follow-up in two cases

Area of Science:

• Pediatric Urology
• Surgical Reconstruction
• Congenital Anomalies

Background:

• Bladder exstrophy is a complex congenital anomaly requiring specialized surgical management.
• Traditional treatments may have limitations in achieving long-term urinary continence and preserving upper urinary tract function.

Observation:

• This study presents two pediatric cases of bladder exstrophy managed with augmentation ureterocystoplasty (UCP).
• Procedures included bladder neck reconstruction and/or division, with appendicovesicostomy for continent diversion (Mitrofanoff principle).

Findings:

• Both patients achieved urinary continence with successful upper urinary tract status and stable renal function over a 5-year follow-up.
• Augmentation UCP facilitated improved bladder capacities (220 cc and 150 cc) managed via clean intermittent catheterization (CIC).
• No significant vesicoureteric reflux (VUR) was observed post-operatively, though one patient required medication for high intravesical pressures.

Implications:

• Augmentation UCP is a viable option for bladder exstrophy when a suitable megaureter is available.
• Combining UCP with bladder neck surgery and continent diversion provides a comprehensive strategy for managing bladder exstrophy.
• This surgical approach holds promise for improving long-term outcomes in patients with bladder exstrophy.