Related Experiment Videos
[Augmentation ureterocystoplasty in children: 7-years follow-up]
Fumi Matsumoto1, Akira Tohda, Kenji Shimada
1Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Insights
Augmentation ureterocystoplasty in children showed initial improvements in bladder capacity and continence. However, long-term results were poor, with two patients requiring repeat surgery due to complications.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Context:
- Neurogenic bladder in children often requires surgical intervention to improve bladder capacity and compliance.
- Augmentation cystoplasty is a common surgical approach for managing refractory neurogenic bladder.
Purpose:
- To evaluate the long-term efficacy and outcomes of augmentation ureterocystoplasty in pediatric patients with neurogenic bladder.
Summary:
- This study retrospectively reviewed four children who underwent augmentation cystoplasty using a dilated ureter.
- Early post-operative results showed increased bladder volume and compliance, with improved continence.
- However, over a mean follow-up of 85 months, two patients experienced hydronephrosis and renal function deterioration, necessitating repeat augmentation cystoplasty with gastrointestinal tissue.
Impact:
- Ureter is not an ideal material for augmentation cystoplasty in older children due to inadequate long-term bladder capacity and compliance.
- Gastrointestinal augmentation may be a more suitable option for achieving sustained bladder enlargement in pediatric neurogenic bladder cases.
Objectives:
We retrospectively reviewed our experience of augmentation ureterocystoplasty in children to evaluate its long-term results.
Materials And Methods:
From February 1996 to March 1999 four children (2 boys and 2 girls) with neurogenic bladder had augmentation cystoplasty using dilated ureter in our institute. After trans-uretero-ureterostomy the lower two thirds of the unilateral ureter was used to perform the augmentation cystoplasty. Follow-up varied between 59 and 96 months (mean 85).
Results:
In early post-operative period bladder volume and compliance increased from 96 (64-150) to 113 (40-220) ml and from 2.7 (1.3-5.8) to 4.5 (2.0-11.0) ml/H2O respectively. Incontinence was improved in all children and two had dry interval of 3-hour catheterization. Although bladder volume and compliance kept increasing gradually (239 (237-241) ml, 11.5 (5.7-18.5) ml/H2O respectively) over 5 years postoperatively, 2 elder patients had repeat augmentation cystoplasty using gastrointestinal tract because of hydronephrosis and deterioration of renal function.
Conclusion:
Our long-term result of ureterocystoplasty was no good. Ureter is not an ideal material to provide adequate bladder capacity and compliance for elder children unless their bladder becomes as large as that of adults early post-operatively.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:25Urinary Tract Calculi VI: Surgical Management