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Published on: August 9, 2012
The use of stomach in pediatric urinary reconstruction
R Gosalbez1, J R Woodard, B H Broecker
1Division of Urology, Emory University, Egleston Children's Hospital, Atlanta, Georgia.
Insights
Continent urinary reservoir with stomach achieved 90% success in pediatric patients, while gastrocystoplasty had 72% success. Both methods aimed for urinary continence and preserved renal function, with rare metabolic complications.
Area of Science:
- Urology
- Pediatric Surgery
- Gastroenterology
Background:
- Urinary incontinence in children often requires surgical intervention.
- Gastric tissue is utilized for bladder augmentation and reconstruction.
- Continent urinary diversion aims to improve quality of life and renal preservation.
Purpose of the Study:
- To compare the outcomes of gastrocystoplasty versus continent urinary reservoir with stomach in pediatric patients.
- To evaluate success rates, upper tract status, renal function, and metabolic balance.
- To assess urodynamic parameters postoperatively.
Main Methods:
- Retrospective analysis of 30 pediatric patients undergoing urinary reconstruction.
- Procedures included gastrocystoplasty (21 patients) and continent urinary reservoir with stomach (9 patients).
- Outcomes assessed by continence, upper tract/renal function, and metabolic/acid-base balance; urodynamics performed postoperatively.
Main Results:
- Continent urinary reservoir achieved 90% success; gastrocystoplasty achieved 72% success.
- Successful outcome defined by >3-hour continence, preserved upper tracts/renal function, and normal electrolytes.
- Metabolic alkalosis with hypergastrinemia occurred in 2 patients; one required gastric segment excision.
Conclusions:
- Continent urinary reservoir with stomach demonstrates higher success rates in pediatric urinary reconstruction compared to gastrocystoplasty.
- Both techniques can achieve good functional and renal outcomes, but metabolic complications require monitoring.
- Further urodynamic evaluation supports the functional assessment of these reconstructive techniques.
Abstract:
We report on 30 consecutive patients (mean age 9 years) who underwent gastrocystoplasty (21) or received a continent urinary reservoir with stomach (9). A successful outcome, defined as complete urinary continence for intervals greater than 3 hours, preservation or improvement of the upper tracts and renal function, and normal electrolyte and acid base balance, was achieved in 90% of the patients who received continent urinary reservoir and 72% of those who underwent gastrocystoplasty. Urodynamic data were obtained in 17 patients in the gastrocystoplasty group and 7 in the continent urinary reservoir group at a mean of 6 months postoperatively. Metabolic alkalosis associated with hypergastrinemia occurred in 2 children. Partial excision of the gastric segment was necessary in 1 patient refractory to medical treatment.
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