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Gastrocystoplasty: long-term followup
E A Kurzrock1, L S Baskin, B A Kogan
1Department of Urology, University of California San Francisco, USA.
Insights
Gastrocystoplasty offers advantages over intestinal augmentation, showing stable upper tracts and improved bladder capacity. While metabolic alkalosis and hematuria-dysuria syndrome can occur, they are manageable with careful patient selection and monitoring.
Area of Science:
- Urology
- Pediatric Surgery
- Gastroenterology
Background:
- Gastrocystoplasty, a bladder augmentation technique using stomach tissue, has faced declining favor due to complications like hematuria-dysuria syndrome and metabolic alkalosis.
- Evaluating the long-term efficacy and safety of gastrocystoplasty is crucial for understanding its role in reconstructive urology.
Purpose of the Study:
- To review institutional experience with gastrocystoplasty for bladder augmentation.
- To determine the advantages and disadvantages of using stomach body wall for bladder augmentation in pediatric patients.
Main Methods:
- Retrospective review of medical records, urodynamic studies, X-rays, and laboratory evaluations for 47 children who underwent gastrocystoplasty (1986-1997).
- Follow-up included telephone interviews with patients/parents, with a mean follow-up of 4.4 years (range: 9 months to 11 years).
- Primary indication for bladder augmentation was neurogenic bladder dysfunction secondary to spinal dysraphism (38 children).
Main Results:
- Upper urinary tracts remained stable or improved in 95% of renal units post-surgery.
- Significant changes in serum electrolytes were not observed, though mean chloride decreased and bicarbonate increased.
- Complications included symptomatic bladder infections (25%), hematuria-dysuria syndrome (27%, higher in non-neurogenic bladders), and one case of bladder stone.
Conclusions:
- Gastrocystoplasty demonstrates advantages over intestinal augmentation, including reduced chloride reabsorption, mucous production, and urinary infections, with low rates of stones and perforation.
- Metabolic alkalosis and hematuria-dysuria syndrome are potential complications but can be managed with appropriate patient selection and follow-up.
- The procedure is not recommended for sensate patients with adequate bowel for augmentation.
Purpose:
Gastrocystoplasty is no longer favored at many institutions due to complications, including the hematuria-dysuria syndrome and metabolic alkalosis. We reviewed our experience to determine the advantages and disadvantages of bladder augmentation using stomach body wall.
Materials And Methods:
We retrospectively reviewed the medical records, urodynamic studies, x-rays and laboratory evaluations of 47 children who underwent gastrocystoplasty at our institution between 1986 and June 1997. Parents and patients were contacted by telephone for detailed interviews to validate the medical record and determine whether there had been any changes since the last visit. Followup ranged from 9 months to 11 years (mean 4.4 years). Bladder dysfunction was secondary to spinal dysraphism in 38 children. Other diagnoses included cloacal and bladder exstrophy, posterior urethral valves, a persistent urogenital sinus and bilateral ectopic ureters.
Results:
Preoperative and postoperative ultrasound studies available for 79 renal units demonstrated a stable or improved upper tract in 75 (95%). Preoperative and postoperative serum sodium, potassium and creatinine levels showed no significant changes. Mean serum chloride decreased 2.7 mEq./l. and bicarbonate increased 3.3 mEq./l. In the 3 patients with renal insufficiency serum bicarbonate increased 8 mEq./l. Mean pressure specific bladder volume at less than 20 cm. water increased 177 cc and mean maximum bladder pressure decreased from 35 to 13 cm. water. Two-thirds of the patients had bacilluria and a fourth reported a symptomatic bladder infection. No patients had bothersome mucus or required routine bladder irrigation. Symptoms consistent with the hematuria-dysuria syndrome were present in 27% of the patients. No patients had symptoms more than once weekly. Symptoms occurred in 75% of the patients without a neurogenic bladder, such as exstrophy or posterior urethral valves, and in 14% of those with neurogenic bladder dysfunction. In 1 case a bladder stone developed 8 years after surgery. Five patients required reoperation for complications related to gastrocystoplasty. No patient had perforation.
Conclusions:
Our data show that even after a mean of 4.4 years gastrocystoplasty has significant advantages over intestinal augmentation, including decreased chloride reabsorption, mucous production and urinary infection, and an extremely low incidence of stones and perforation. The gastric patch is associated with metabolic alkalosis and the hematuria-dysuria syndrome, which may be avoided and medically treated with proper patient selection and close followup. The procedure should be avoided in sensate patients with sufficient bowel.