[Urinary bladder augmentation using the stomach in patients with compensated renal insufficiency]

Area of Science:

• Urology
• Nephrology
• Surgical Reconstruction

Background:

• This case report details a patient with complete congenital bladder exstrophy and chronic compensated renal insufficiency.
• Previous reconstructive surgeries and temporary renal fistulas were performed due to low-capacity bladder and urinary stasis.
• Progressive renal damage and obstructive uropathy led to consideration of advanced surgical interventions.

Observation:

• The patient declined conventional wet stoma diversions, necessitating an alternative continent urinary management strategy.
• A gastrocystoplasty (urinary bladder augmentation using the stomach) with a Mitrofanoff cutaneous vesicostomy was performed.
• The patient now manages urinary diversion via self-catheterization six times daily under urological and nephrological supervision.

Findings:

• Gastrocystoplasty serves as an alternative to traditional neobladder construction from bowel segments, especially for patients with compromised renal function.
• While specific complications exist, malignant degeneration within the augmented gastric segment or exposed urothelium has not been reported.
• Pathological and precancerous mucosal alterations have been observed, highlighting the need for regular endoscopic monitoring.

Implications:

• Gastrocystoplasty is a crucial option for managing complex bladder exstrophy cases in patients with poor or compensated renal function.
• Long-term surveillance, including endoscopy and biopsy, is essential to monitor for precancerous changes in the augmented gastric segment and urothelium.
• This case underscores the importance of patient preference in surgical planning for continent urinary diversion.