[Bladder augmentation cystoplasty with continent urinary diversion by ileo-caeco-appendicular graft in children]

Area of Science:

• Pediatric Urology
• Surgical Reconstruction
• Urinary Diversion

Background:

• Augmentation cystoplasty and continent urinary diversion are complex procedures for managing dysfunctional bladders in children.
• Ileo-caeco-appendicular grafts offer a potential solution for bladder augmentation and creating a continent stoma.
• This study evaluates a combined approach in challenging pediatric urological cases.

Observation:

• Two pediatric patients, a 3-year-old girl and an 8-year-old boy, underwent augmentation cystoplasty with Mitrofanoff appendicostomy and ureteral reimplantation.
• Indications included a pseudoneurogenic bladder with high-grade reflux and a scarred bladder post-ureterocele surgery.
• The procedure was performed as a single-stage operation.

Findings:

• The combined technique successfully increased bladder capacity to approximately 300 ml in both patients.
• Incontinence was managed effectively through intermittent catheterization via the abdominal stoma.
• Significant resolution of upper urinary tract dilatation was observed within one year post-operatively.

Implications:

• This combined surgical approach is a valuable, conservative option for complex pediatric urological conditions.
• It addresses small, non-compliant bladders, incontinence, and severe upper tract dilatation.
• The technique serves as an alternative to more extensive salvage diversion procedures.