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Treatment of iatrogenic functional or morphologic bladder loss
M Stöckle1, J W Thüroff, H Riedmiller
1Department of Urology, Medical School, University of Mainz, Federal Republic of Germany.
Insights
Ileocecal cystoplasty (Mainz-pouch technique) effectively restored bladder function in six pediatric patients with iatrogenic bladder loss. The procedure resulted in complete continence for most, enabling natural voiding without residual urine.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Bladder Augmentation
Background:
- Iatrogenic bladder loss in children necessitates reconstructive surgery.
- Indications include incontinence and upper urinary tract compromise.
- Previous urinary diversion methods were considered.
Observation:
- Six children (4-13 years) underwent ileocecal cystoplasty (Mainz-pouch technique).
- Reasons included functional/morphologic bladder loss, incontinence, or reflux.
- Two patients had prior sigmoid conduit diversion.
Findings:
- Five of six children achieved complete urinary continence post-operation.
- One boy experienced decreasing nocturnal enuresis due to sphincter weakness.
- All patients could void augmented bladders without residual urine.
Implications:
- Ileocecal cystoplasty is a viable option for pediatric bladder reconstruction.
- The Mainz-pouch technique demonstrates good functional outcomes.
- Successful voiding and continence improve quality of life.
Abstract:
From 1984 to 1986, six children from 4 to 13 years of age, received a bladder augmentation by ileocecal cystoplasty (Mainz-pouch technique) because of an iatrogenic functional or morphologic bladder loss. Indications for operation were incontinence due to the low bladder capacity or threat to the upper urinary tract due to ureteral obstruction or vesicorenal reflux. Two of the children had already undergone supravesical urinary diversion by sigmoid conduit. After a follow-up period of 2 to 19 months, (mean 11 months), five of the six children are completely continent. One boy with a known weak sphincter still has slight, but decreasing, enuresis nocturna in periods of complete filling of the pouch, 1 month after the operation. All children are able to void their augmented bladders without residual urine.