A therapeutic method for failed bladder augmentation in children: re-augmentation.
OBJECTIVE
To investigate the causes leading to the deterioration of previously successful bladder augmentation and to evaluate the efficacy of re-augmentation.


METHODS
Between 1988 and 2004, 136 bladder augmentations were performed in two paediatric urological units in Hungary and Turkey. Re-augmentation was necessary in two patients after colocystoplasty and in three after gastrocystoplasty. A secondary augmentation was not required in any patients after ileocystoplasty. The clinical data of these five patients were evaluated.


RESULTS
On the basis of the clinical signs and urodynamic studies, re-augmentation was performed 2-7 years after the initial augmentation cystoplasties. Anticholinergic therapy given before re-augmentation did not improve bladder capacity, intravesical pressure and/or bladder compliance. An ileal or sigmoid segment was used for the secondary augmentation. After re-augmentation, all five patients became continent, and showed marked improvement in their urodynamic parameters at a mean (range) follow-up of 6.8 (2-10) years.


CONCLUSIONS
A decreased bladder capacity and/or compliance and increased bladder pressure after successful augmentation cystoplasty might be the result of: (i) impairment of the blood supply to the large bowel or gastric segment used for augmentation; or (ii) bowel mass contractions. Ileocystoplasty seems to be the "first-line" of choice for primary augmentation. Re-augmentation with a bowel segment is a suitable treatment if conservative treatment fails. Regular urodynamic investigations are needed for early detection of malfunction of the augmented bladder, and advising therapy.
Vajda
Peter
P
Department of Paediatrics, Surgical Unit, Faculty of Medicine, University of Pecs, Pecs H-7623, Hungary. peter.vajda@aok.pte.hu
Buyukunal
Cenk S N
CS
Soylet
Yunus
Y
Danismed
Nur
N
Juhasz
Zsolt
Z
Pinter
Andrew B
AB
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006814:Hungary; D007422:Intestines / Q000601:surgery; D012086:Reoperation; D017211:Treatment Failure; D014421:Turkey; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000601:surgery*; D016476:Urinary Reservoirs, Continent