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Continent gastric pouch

M C Carr1, M E Mitchell

  • 1University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105, USA.

World Journal of Urology
|January 1, 1996
PubMed
Summary
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Gastric tissue reconstruction for lower urinary tract issues achieved continence in all 12 pediatric patients. Despite complications, perseverance ensured adequate urine storage and urinary continence.

Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • This study evaluates the long-term efficacy and complications of using gastric tissue for total lower urinary tract reconstruction in pediatric patients.
  • Investigated were 12 patients (9 female, 3 male) with complex urogenital anomalies, including cloacal exstrophy and bladder exstrophy, between 1985 and 1995.

Observation:

  • Seven patients underwent total gastric bladder substitution, while five had composite continent reservoirs combining stomach and bowel segments.
  • The mean follow-up was 4.5 years, with an average bladder capacity of 309 ml and compliance of 12.9 ml/cmH2O.
  • All patients achieved urinary continence, though continence mechanisms frequently required revisions.

Findings:

  • The primary complications involved the continence mechanism (6 patients requiring revision) and ureterovesical junction obstruction (3 patients).

Related Experiment Videos

  • Metabolic alkalosis occurred in two patients, and one experienced renal deterioration due to obstruction.
  • Despite initial challenges, persistent surgical management led to successful outcomes in all cases.

    • Implications:

    • Gastric tissue is a viable option for lower urinary tract reconstruction in children, offering adequate bladder capacity and achieving continence.
    • Careful surgical technique and management of complications, particularly those related to the continence mechanism, are crucial for long-term success.
    • This reconstructive approach demonstrates the potential for achieving total urinary continence and satisfactory urine storage in complex pediatric urogenital conditions.