[Urinary bladder augmentation using the stomach in patients with compensated renal insufficiency].
This case report describes a female patient with bladder exstrophy and chronic compensated renal insufficiency as it relates to the topic of urinary bladder augmentation using the stomach and cutaneous vesicostomy with a Mitrofanoff continent stoma. Due to complete congenital bladder exstrophy the patient underwent functional reconstructive surgery for cystoschisis and several revision procedures. Because of a low-capacity, low-compliance bladder with bilateral urinary stasis in the kidneys, temporary percutaneous renal fistulas were created on both sides. After the patient had declined any follow-up during her pubertal years, advanced bilateral renal damage ensued. In a state of compensated renal insufficiency with creatinine levels >2 mg/dl, the patient was offered surgery for placement of an incontinent bladder substitute as an ileal or colon conduit because of the progressive kidney damage with obstructive uropathy. Since the patient rejected any form of wet stoma despite several consultations, after adequate preparations were met, a gastrocystoplasty and Mitrofanoff cutaneous vesicostomy with an umbilical stoma and artificial umbilicoplasty were performed. The patient catheterizes herself six times daily and is under close urological/nephrological supervision.In exceptional cases, gastrocystoplasty is an alternative to construction of a neobladder from bowel segments. It is particularly indicated for patients with compensated or already poor kidney function. The interventions are associated with several specific complications. There have as yet been no reports of malignant degeneration inside the gastric portion used for augmentation or the urothelium exposed to stomach acid. However, pathological and precancerous alterations of mucous membranes have been observed, which should be regularly monitored by endoscopy/biopsy and warrant further long-term studies.
Zugor
V
V
Urologische Klinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. vahudin.zugor@uro.imed.uni-erlangen.de
Schreiber
M
M
Klein
P
P
Schott
G E
GE
D000328:Adult; D001746:Bladder Exstrophy / Q000601:surgery*; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D013270:Stomach / Q000637:transplantation*; D013536:Suture Techniques; D001743:Urinary Bladder / Q000601:surgery*; D014546:Urinary Catheterization; D014547:Urinary Diversion / Q000379:methods; D016476:Urinary Reservoirs, Continent