Augmentation ureterocystoplasty in children with neurogenic bladder
Article published in Urologia Polska 2002/55/1.

authors

Lidia Skobejko-Włodarska, Jerzy Czyż, Krystyna Strulak, Piotr Gastoł, Czesław Szymkiewicz, Małgorzata Baka-Ostrowska, Jan Karol Wolski, Mieczysław Śmigielski

Klinika Urologii Dziecięcej Instytutu „Pomnika - Centrum Zdrowia Dziecka\" w Warszawie Kierownik kliniki: dr hab. Małgorzata Baka-Ostrowska

keywords

bladddcr, neurogenic bladder dysfunction, non-function kidney, urctcrocystoplasty

summary

Objective. To present long-term outcomes of augmentation ureterocystoplasty.

Patients and methods. Since 1995 to 1999 augmentation ureterocystoplasty was performed in 11 children with non-functioning kidney with megaureter and neurogenic bladder dysfunction following meningocoele repair. 7 patients did not benefited from earlier intermittent catheterisation and anticholinergic therapy. Mean patient age 7,3 years (range 1-17). Eight children required ventriculo-peritoneal shunt because of hydrocephalus. Megaureter was produced by severe vesicoureteral reflux and by vesicoureteral junction stenosis in 9 and 2 individuals, respectively. Single cases of cross renal ectopia of non-functioning kidney or duplex kidney with non-functioning lower pole or renal insufficiency were observed. The urodynamic study proceeding ureterocystoplasty in all children revealed small bladder capacity and high intravesical pressure, which were caused by low compliance bladder in 7 children or by detrusor hyperactivity in 2 children or both in 2 children.

During ureterocystoplasty nephrectomy was performed. Both ureters were used for augmentation in one patient with renal insufficiency to prepare bladder for future renal transplant. MACE procedure (Malone Antegrade Continence Enema) was performed in one patient. In another the appendix was long enough, to be divided and used for MACE procedure and for the Mitrofanoff stoma.

Results. Patients follow up ranged from one to five years. In urodynamic study bladder capacity increased and intravesical pressure decreased in 9 and 10 patients, respectively

Conclusions. Ureterocystoplasty is a treatment regimen for selected patients with neurogenic bladder dysfunction and non-functioning kidney with megaureter. Retroperitoneal surgical procedure is important in children with renal insufficiency, because the intraabdominal cavity is preserved for future peritoneal dialysis and in children with ventriculoperitoneal shunt. Augmentation ureterocystoplasty facilitates bladder preparation for kidney transplant in children with renal insufficiency.

references

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