title: Objective long-term evaluation after bladder autoaugmentation with rectus muscle backing.
abstract: OBJECTIVE
  Bladder autoaugmentation with rectus muscle backing is an efficient surgical technique for bladder augmentation. We evaluated long-term outcomes to determine the value of this procedure.
  
  
  METHODS
  Between August 1999 and June 2004 autoaugmentation was performed in 16 girls and 7 boys 4 to 13 years old (median age 8). The indication was neurogenic bladder with small capacity and poor compliance due to myelomeningocele in 18 patients, tethered cord in 3 and sacral agenesis in 2. Detrusorectomy usually involved the whole upper half of the bladder. The prolapsed bladder urothelium was hitched to the 2 rectus muscles to prevent retraction and provide easier bladder emptying with voluntary muscle contractions.
  
  
  RESULTS
  At the median early followup of 27 months (range 9 to 49) bladder volume had increased significantly in all 23 patients (median 338 ml, range 190 to 462). At the current median long-term followup of 134 months (range 94 to 159) bladder volume continued to be significant compared to median bladder capacity preoperatively (median 419 ml, range 296 to 552). Voluntary voiding was achieved in 14 patients without post-void residual urine. Nine patients used clean intermittent catheterization, of whom only 4 could not empty the bladder voluntarily and relied only on clean intermittent catheterization.
  
  
  CONCLUSIONS
  Detrusorectomy with a rectus muscle hitch and backing is a minimally invasive, completely extraperitoneal, simple and safe procedure. However, the technique is indicated only in select cases without anterior abdominal wall anomalies.
authors: School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia. Electronic address: djordjevic@uromiros.com.
authors: Miroslav L
authors: ML
authors: Djordjevic
authors: School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
authors: Vojkan
authors: V
authors: Vukadinovic
authors: University Children's Hospital, Belgrade, Serbia.
authors: Borko
authors: B
authors: Stojanovic
authors: University Children's Hospital, Belgrade, Serbia.
authors: Marta
authors: M
authors: Bizic
authors: School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
authors: Zoran
authors: Z
authors: Radojicic
authors: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Dejan
authors: D
authors: Djordjevic
authors: School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
authors: Zoran
authors: Z
authors: Krstic
mesh_terms: D000293:Adolescent; D064592:Autografts; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D019459:Urothelium / Q000601:surgery
keywords: neurogenic; reconstructive surgical procedures; rectus abdominis; urinary bladder; urination; urothelium