title: Complications after use of gastric segments for lower urinary tract reconstruction.
abstract: OBJECTIVE
  We retrospectively reviewed our experience with the use of gastric segments for lower urinary tract reconstruction with an emphasis on long-term complications.
  
  
  METHODS
  A total of 29 patients underwent reconstruction of the lower urinary tract using gastric segments between 1993 and 2000. Diagnoses included neurogenic bladder (21), cloacal exstrophy (5), solitary kidney/ectopic ureter (1), posterior urethral valves (1) and rhabdomyosarcoma of prostate (1). Gastric segment was used as gastrocystoplasty (21), composite gastroenteric cystoplasty (6), demucosalized gastrocystoplasty (1) and continent gastric reservoir (1).
  
  
  RESULTS
  Mean followup was 13.9 years (range 9 to 16.5). Complications were seen in 15 (51.7%) patients. Seven patients had the hematuria-dysuria syndrome, which was intractable in 1 and necessitated excision of the gastric patch. Due to severe complications necessitating major reoperations 3 patients underwent re-augmentation with enteric segments without excision of the gastric tissue (composite). One patient who underwent demucosalized gastrocystoplasty had excision of the gastric tissue and re-augmentation with enteric segment due to contraction of the gastric patch. A stone developed in 1 patient with a composite gastroenteric reservoir. Malignancy developed in the reservoir in 3 patients 11, 12 and 14 years after gastrocystoplasty, and all 3 died of metastasis.
  
  
  CONCLUSIONS
  We do not recommend the use of gastric segments for reconstruction of the lower urinary tract due to the high incidence of reoperations and complications. In patients in whom gastric segments were used in the past for lower urinary tract reconstruction, regular surveillance and close followup are strongly advocated.
authors.affiliation: Division of Pediatric Urology, Miami Children's Hospital, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA. miguel.castell@gmail.com
authors.forename: Miguel
authors.initials: M
authors.lastname: Castellan
authors.forename: Rafael
authors.initials: R
authors.lastname: Gosalbez
authors.forename: Yuval
authors.initials: Y
authors.lastname: Bar-Yosef
authors.forename: Andrew
authors.initials: A
authors.lastname: Labbie
mesh_terms: D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013270:Stomach / Q000637:transplantation*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D055815:Young Adult