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[Gastrocytoplasty in pediatric patients--initial clinical experience with 5 cases]
K Ueoka1, S Tanikaze, Y Sugita
1Department of Pediatric Urology, Kobe Children's Hospital.
Insights
Gastrocytoplasty using a gastric segment effectively treated bladder dysfunction and incontinence in pediatric patients. This method improved bladder volume and renal function without metabolic complications, showing promise for bladder augmentation.
Area of Science:
- Urology
- Pediatric Surgery
- Gastroenterology
Context:
- Bladder dysfunction and incontinence in children pose significant challenges.
- Neurogenic bladder, bladder exstrophy, and trauma are common etiologies.
- Augmentation cystoplasty is a surgical option to improve bladder capacity and function.
Purpose:
- To evaluate the efficacy and safety of gastrocytoplasty in pediatric patients.
- To assess the impact of gastric augmentation on bladder volume, renal function, and continence.
- To compare the outcomes of gastrocytoplasty with intestinal augmentation.
Summary:
- Five pediatric patients (ages 5-14) underwent gastrocytoplasty for bladder augmentation.
- The procedure involved isolating a gastric segment and augmenting the bladder, with variations in urethral management.
- Postoperative follow-up (18-22 months) showed increased bladder volume, improved upper urinary tract dilatation, and resolution of incontinence.
Impact:
- Gastrocytoplasty demonstrated favorable outcomes, including improved bladder capacity and renal function, without significant metabolic derangements.
- The gastric segment proved to be a viable alternative to intestinal segments for augmentation cystoplasty.
- This technique offers a promising solution for managing complex bladder dysfunction in pediatric populations.
Abstract:
Gastrocytoplasty was undertaken for 5 patients with bladder dysfunction and incontinence caused by neurogenic bladder in 3 cases, bladder exstrophy in 1 case and trauma in 1 case respectively. The age of the patients ranged from 5 years through 14 years at the operation. Decreased renal function was recognized in 3 cases with neurogenic bladder before reconstruction. The other 2 cases had normal renal function. Gastric segment was isolated with right gastroepiploic artery as a pedicle. Bladder was opened vertically and augmented with gastric segment. In 4 cases urethrogastrostomy with submucosal tunnel was performed in both sides. In neurogenic bladder cases, urethra was left without any surgical intervention, while other 2 cases underwent continent diversion using Mitrofanoff principle with urethra being closed. Postoperative follow up period was 18 to 22 months. All cases had increased bladder volume and the dilatation of upper urinary tract disappeared or decreased in size in those who had upper urinary tract dilatation before operation. Urinary incontinence completely disappeared in continent diversion cases. In neurogenic bladder cases urinary leakage through urethra was negligible with 4 hour interval clean intermittent catheterization. Laboratory examination showed no metabolic derangement in blood gas analysis and electrolytes even in those who had decreased renal function. Blood urea nitrogen (BUN) and serum creatinine showed a little improvement or the same level as before. We didn't encounter any troubles in CIC such as the obstruction caused by mucus produced by gastric segment. From our experience with those 5 pediatric cases underwent gastrocystoplasty, we thought gastric segment had some advantage as a tissue for augmentation cystoplasy compared with intestinal segment.