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Functional outcome and specific complications of gastrocystoplasty for failed bladder exstrophy closure
A El-Ghoneimi1, C Muller, J M Guys
1Department of Pediatric Urology, Hôpital La Timone, Marseilles, France.
Insights
Gastrocystoplasty for failed bladder exstrophy closure yielded limited success. While some achieved continence, complications like dysuria and gastric issues suggest reconsidering this approach for bladder augmentation.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Bladder Augmentation
Background:
- Bladder exstrophy closure failures necessitate alternative reconstructive strategies.
- Gastrocystoplasty has shown initial promise for bladder augmentation.
Purpose of the Study:
- To assess the functional outcomes of gastrocystoplasty in children with failed bladder exstrophy closure.
- To evaluate complications associated with using gastric tissue for bladder augmentation.
Main Methods:
- Gastrocystoplasty was performed on 22 children with small, poorly compliant bladders after failed exstrophy reconstruction.
- Follow-up ranged from 6 months to 6 years.
Main Results:
- Complete urinary continence was achieved in 64% of patients.
- Significant post-voiding residual urine was noted in 60% of patients.
- Complications included dysuria, hematuria, gastric patch perforation, and gastric ulcer.
Conclusions:
- The disadvantages of gastrocystoplasty outweigh its benefits in failed bladder exstrophy closure.
- Dysuria and potential safety issues like perforation necessitate caution.
- Insufficient and inconsistent bladder capacity augmentation, often requiring intermittent catheterization for continence, limits its efficacy.
Purpose:
The encouraging initial results of gastrocystoplasty led us to perform it for failed bladder exstrophy closure. We assess the functional outcome of the augmented bladder and evaluate complications related directly to use of the stomach in this specific group of children.
Materials And Methods:
We performed gastrocystoplasty in 22 children an average of 9.5 years old with a small, poorly compliant bladder after staged reconstruction of bladder exstrophy failed. Followup ranged from 6 months to 6 years (mean 3 years).
Results:
Complete urinary continence was achieved in 14 children (64%). Voiding via the urethra was possible in 13 patients (60%) but post-voiding residual urine was significant in 12. Bladder capacity increased from a mean of 77 to 270 ml. Bladder capacity decreased during followup in 3 children, requiring repeat augmentation. Six children had isolated dysuria and 2 had dysuria with hematuria. Perforation of the gastric patch and a bleeding gastric ulcer occurred in 1 patient each.
Conclusions:
The disadvantages of gastrocystoplasty outnumber its advantages after failed bladder exstrophy closure. Urethral sensation makes dysuria a major discomfort. Safety is not optimal, since perforation may occur. Voiding is not efficient because gastrocystoplasty provides continence only when it is associated with intermittent catheterization. Bladder capacity is insufficiently augmented and inconsistent during followup. We believe that the use of gastrocystoplasty in cases of failed bladder exstrophy closure should be reconsidered.
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