Bladder augmentation: ureterocystoplasty versus ileocystoplasty.
The primary advantages of augmentation ureterocystoplasty include the absence of mucus, lack of electrolyte absorption from the augmenting segment and the avoidance of gastrointestinal complications. We tested whether the ureteral patch offers sufficient biomaterial to increase adequately the storage efficiency of dysfunctional bladders. Between April 1989 and November 1992, 8 children with unilaterally dilated and tortuous ureters underwent bladder augmentation using detubularized reconfigured megaureter. Clinical and urodynamic outcomes were compared between these patients and a control group of 8 children matched in age and diagnosis who had undergone ileocystoplasty during the same time. Total bladder capacity, pressure specific bladder volume at pressure less than 30 cm. water, dynamic analysis of bladder compliance, continence and upper tract status were compared between the 2 groups before and after augmentation. Preoperatively, all 16 patients were incontinent with high pressure, small capacity bladders, and all had upper tract changes. Postoperatively, the mean total bladder capacity was 417 ml. in the ureterocystoplasty group and 381 ml. in the ileocystoplasty group (p > 0.05), while the mean pressure specific bladder volume was 413 and 380 ml. (p > 0.05), respectively. Pressure specific bladder volume and dynamic bladder compliance were normal in 7 of 8 patients (87.5%) in the ureterocystoplasty group. All patients in the ileocystoplasty group had normal postoperative urodynamics. We conclude that megaureters subtending effete kidneys may be used to improve the storage function of dysfunctional bladders to the same extent as that achieved with ileum without the complications pursuant to ileocystoplasty, and that the improvement is maintained long term.
Hospital for Sick Children, Toronto, Canada.
E H
EH
Landau
V R
VR
Jayanthi
A E
AE
Khoury
B M
BM
Churchill
R F
RF
Gilmour
R E
RE
Steckler
G A
GA
McLorie
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003187:Compliance; D004108:Dilatation, Pathologic / Q000150:complications / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000601:surgery; D007223:Infant; D008297:Male; D011312:Pressure; D014513:Ureter / Q000601:surgery; D014515:Ureteral Diseases / Q000150:complications / Q000601:surgery; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics