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Enterocystoplasty in the management and reconstruction of the pediatric neurogenic bladder
Insights
Enterocystoplasty effectively treats neurogenic bladder in pediatric patients, achieving continence in most cases. Many patients require ongoing medication and antimicrobial treatment for optimal management.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Nephrology
Background:
- Neurogenic bladder in children and young adults presents challenges in bladder compliance and continence.
- Urinary undiversion and management of incontinence often require complex surgical interventions.
Purpose of the Study:
- To evaluate the efficacy of enterocystoplasty in managing neurogenic bladder in pediatric and young adult patients.
- To assess the outcomes of enterocystoplasty for urinary undiversion and treatment of incontinence.
Main Methods:
- Enterocystoplasty using various techniques including tubular sigmoid, ileocecal segments, or bowel patches.
- Simultaneous or subsequent procedures like bladder neck reconstruction and artificial sphincter placement.
- Follow-up assessment of continence, need for clean intermittent catheterization, and medication requirements.
Main Results:
- 16 out of 17 available patients achieved continence with clean intermittent catheterization (CIC) every 3-4 hours after a mean follow-up of 20 months.
- Nine patients required medication (anticholinergic or smooth muscle relaxants) to enhance functional bladder capacity.
- Most patients needed chronic antimicrobial therapy to manage bacteriuria.
Conclusions:
- Enterocystoplasty is a viable surgical option for improving bladder function and achieving continence in pediatric patients with neurogenic bladder.
- While successful in achieving continence, long-term management often involves medication and antimicrobial treatment.
- Further research may explore optimizing surgical techniques and medical management to reduce long-term complications.
Abstract:
Eighteen children and young adults with neurogenic bladder underwent enterocystoplasty as part of urinary undiversion or for treatment of incontinence associated with reduced bladder compliance or detrusor sphincter dyssynergia. In 12, tubular sigmoid enterocystoplasty with transureteroureterostomy was performed with the smaller diameter ureter implanted into the bowel tenia. In two patients the ileocecal segment was used to augment the bladder, and the ureters were anastomosed to the ileum. In four patients the cecum or a patch of sigmoid colon was used to augment the bladder. Young-Dees bladder neck reconstruction was performed on eight patients at the time of surgery; one later required bladder neck reconstruction, and two later required an artificial sphincter. After a mean follow-up of 20 months, 16 of the 17 available for follow-up are continent with clean intermittent catheterization every 3 to 4 hours. Nine patients require anticholinergic or smooth muscle relaxing medication to increase functional bladder capacity. Most of the patients need chronic antimicrobial treatment to control bacteriuria.