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Abstract
Purpose
This paper reviews a single center experience of augmentation cystoplasty cases.
Material and Methods
Of the 145 patients who have undergone augmentation (AG) cystoplasty between 1994
and 2006, 112 (54 M 58 F, mean age 10.5 years (3-25), were available for long term
follow-up, with a mean follow-up period of 42 months (12-114). Indications for AG
were: neurogenic bladder (n = 79), undiversion (12), bladder exstrophy (8), posterior
urethral valve (8), and Hinman syndrome (5). Ileocystoplasty was done for 65 cases,
autoaugmentation (AA) for 34 cases, gastrocystoplasty in five, and ureterocystoplasty
in eight cases. Additional procedures included: Mitrofanoff (57), sling or bladder
neck reconstruction (23), and anti-reflux (AF) procedures (25).
Results
Continence was achieved in 74% with augmentation, and 91% with additional procedures.
The average bladder capacity was 41% of the capacity expected for age and mean compliance
was 4 ml/cmH2O which were increased to an average of 85% and 12.9 ml/cmH2O respectively. The improvement in capacity and compliance with AA was the lowest.
Of the 67 patients with VUR, 25 had an AF procedure with a success rate of 84% (21/25).
In the remaining 42, reflux was not corrected surgically, and 20 had no reflux following
augmentation procedure (47.6%), 13 persisted (31%), 6 had downgrading (14.3%), 3 had
unilateral resolution (7.1%). Overall complications were seen in 30.4%. The most common
complication was pyelonephritis in 7%, 8 patients required revision of Mitrofanoff
stoma, bladder stones were in 3.6%. The remaining complications were all minor seen
in 1-2% each.
Conclusions
Ileocystoplasty is still considered the first choice if the prerequisites of uroepithelial
cystoplasty are absent. AA should be restricted to the detrusor hyperactivity group,
AF procedure should only be done in high grade reflux and good care must be considered
in the presence of previous pelvic surgery.
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Article info
Publication history
# S07-7 (O)
Identification
Copyright
© 2008 Published by Elsevier Inc.
