Ureterocystoplasty

Augmentation cystoplasty is the treatment of choice for the hyperreflexic, poorly compliant bladder unresponsive to medical treatment. While the etiology for such bladders is multiple, the clinical manifestations are few and include urinary incontinence, urinary tract infections, and upper tract deterioration. When such bladders are accompanied by hydroureteronephrosis with or without reflux, the dilated ureter and pelvis may be used to augment the bladder. Ureterocystoplasty is rapidly gaining acceptance among pediatric urologic surgeons. Dilated ureter is clearly the best tissue available for augmentation. It is lined with transitional cell epithelium, and the muscular backing provides the necessary properties for a compliant reservoir. The lack of mucous production and absorptive or secretory properties of urothelium prevents some of the most common problems encountered with other forms of augmentation cystoplasty (e.g., metabolic abnormalities, mucous production, lithiasis, and recurrent infections). The use of urothelium also eliminates the long-term concern of malignant degeneration of bowel used in augmentation.