Related Experiment Videos
Pediatric applications of augmentation cystoplasty: the Johns Hopkins experience
Insights
Augmentation cystoplasty in children with bladder exstrophy and other conditions offers a reliable alternative to urinary diversion. This reconstructive surgery helps manage small bladders, with most patients achieving continence via intermittent catheterization.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Bladder Augmentation
Background:
- Children with congenital anomalies often present with noncompliant bladders.
- Conditions include bladder exstrophy, cloacal exstrophy, meningomyelocele, sacral agenesis, and prune belly syndrome.
- Urinary diversion is a common management strategy, but bladder augmentation offers an alternative.
Purpose of the Study:
- To evaluate the efficacy and complications of augmentation cystoplasty in pediatric patients.
- To assess the long-term outcomes of bladder augmentation as a reconstructive option.
- To compare augmentation cystoplasty with traditional urinary diversion methods.
Main Methods:
- A retrospective review of 23 children undergoing augmentation cystoplasty since 1976.
- Various bowel segments (ileum, ileocecal, sigmoid, hindgut) were used for bladder augmentation.
- Some cases involved urinary undiversion or artificial urinary sphincter placement.
Main Results:
- No urinary fistulas or rediversions occurred.
- Complications included acidosis (2 patients), ureteral obstruction (1), sphincter erosion (1), ileocecal valve reflux (1), and small bowel obstruction (1).
- 18 patients achieved dryness with intermittent self-catheterization; 3 were voiding and continent.
Conclusions:
- Augmentation cystoplasty is a reliable reconstructive option for children with small, noncompliant bladders.
- It provides a viable alternative to urinary diversion, improving bladder capacity and continence.
- Careful patient selection and surgical technique are crucial for successful outcomes.
Abstract:
Since 1976, 23 children with bladder or cloacal exstrophy, meningomyelocele, sacral agenesis, the prune belly syndrome and noncompliant bladders associated with urethral valves or prior diversion underwent augmentation cystoplasty. Of these procedures 7 were combined with some type of urinary undiversion. Bowel segments used for augmentation included ileum alone in 10 patients, ileocecal segments in 4, a sigmoid patch in 8 and a hindgut patch in 1. An artificial urinary sphincter was placed at the time of bladder augmentation in 3 patients. There were no urinary fistulas or cases of urinary rediversion. Two patients required oral alkalizing agents as a result of persistent systemic acidosis. One patient required reoperation twice for ureteral obstruction, 1 had removal of the sphincter device secondary to erosion, 1 required reinforcement of the ileocecal valve owing to persistent reflux and 1 required reoperation for small bowel obstruction. Other complications included a superficial wound infection and 5 urinary tract infections, all of which were managed easily. Three patients were voiding and continent, 18 were dry with intermittent self-catheterization, 1 had giggle incontinence and 1 remained incontinent after sphincter removal. Augmentation cystoplasty appears to offer a reliable alternative to urinary diversion in the reconstructive management of children with small capacity bladders.