PTU - Polskie Towarzystwo Urologiczne
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Bladder augmentation in children
Article published in Urologia Polska 2004/57/3.

authors

Wojciech Apoznański 1, Jerzy Czernik 1, Tomasz Szydełko 1, Rafał Chrzan 2
1 Katedra i Klinika Chirurgii i Urologii Dziecięcej Akademii Medycznej we Wrocławiu
Kierownik kliniki: prof. dr hab. Jerzy Czernik
2 Katedra i Klinika Urologii Akademii Medycznej we Wrocławiu
Kierownik kliniki: prof. dr hab. Jerzy Lorenz

keywords

lower urinary tract, neurogenic dysfunction, operative treatment, children

summary

introduction
Neurogenic dysfunction of the lower urinary tract is the result of the damage of the nervous system responsible for its proper functioning. In children the damage is usually caused by congenital defects of the central nervous system such as meningomyelocoele or hydrocephalus. But it may also be a consequence of a traumatic rupture of the spinal cord, or of a degenerating disease of the CNS.
Bladder augmentation has recently become an important element in the treatment of neurogenic dysfunction of the lower urinary tract. The optimal therapy is yet to be found. The disputable issues are when the operation should be performed (the child's age, the condition of the lower urinary tract) and what material should be used for the augmentation.
The development of urodynamic examinations by means of which we can monitor the intravesical pressure has made it possible to successfully handle all types of neurogenic dysfunction of the lower urinary tract.
aim
The objective is to analyze the results of the treatment of neurogenic dysfunction of the lower urinary tract in children operated on in the Clinic of Child Surgery and Urology, Wrocław University of Medicine from 2000 to 2003. Operative procedures will be compared and postoperative complications will be discussed.
material and method
From 2000 to 2003, thirty three bladder augmentations were performed in the Clinic of Child Surgery and Urology at the University of Medicine in Wrocław. In 30 cases the surgery was carried out in children with neurogenic dysfunction of the bladder. In 3 cases it was performed in boys with the posterior urethral valve. Urodynamic examination was the basic criterion to select patients for the augmentation. Children who showed sustaining symptoms of hyperreflexion of the detrusor and low compliance of the bladder wall even though they had been treated with parasympaticolytics for a year were selected for the treatment.
Eight operations made use of a fragment of the ileum. Twelve surgeries used a part of the colon. In 3 cases ileo-coecal segment was used; in further 3-major curvature of the stomach. Ureterocystoplasty was performed 5 times. Autoaugmentation was carried out twice.
results
One child died on the 14th day after sigmoideocystoplasty because of metabolic disorders. In most cases, however, the operation brought the improvement of the urodynamic parameters of the bladder. In 14 cases continence improved. In 20 patients vesico-ureteral reflux disappeared.
As for postoperative complications, one case of massive lithiasis in the augmented bladder and three cases of metabolic acidosis were noted.
conclusions
1. Bladder augmentation is extremely important in the treatment of NVD.
2. No procedure is free from complications.
3. None of the examined procedures can be considered optimal.