PTU - Polskie Towarzystwo Urologiczne
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CODE: 17 - Autoaugmentation (detrusotomy) - successful option or failure?
Article published in Urologia Polska 2006/59/Suplement 1.


Lidia Skobejko-Włodarska, Karina Felberg, Piotr Gastoł, Małgorzata Baka-Ostrowska
Klinika Urologii Dziecięcej - Instytut CZD w Warszawie


Introduction. Autoaugmentation is simple method of bladder augmentation with creation of a large diverticulum from intact bladder mucosa after removing of detrusor.
The aim of the study. Evaluation of usefulness of autoaugmentation in lowering high intravesical pressure and enlargement of bladder capacity.
Material and method. Autoaugmentation was performed in 30 patients with neuropathic bladder after myelomeningocele repair aged from 1.1 to 16.0 years (median age 8.9 years). There were 27 girls and 3 boys. In 18 patients dilatation of upper urinary tract with development of hydroureteronephrosis in 5 of them was observed. In 10 patients vesico-ureteral reflux was diagnosed. Urodynamic study showed high intravesical pressure from 48 to 182 cm H2O (median pressure 85 cm H2O) and bladder capacity from 66 to 400 ml (median capacity 172 ml). Indications were: high intravesical pressure with low compliance of bladder wall in 25 patients, detrusor overactivity in 4 and mixed form in 1 patient. At the beginning of patients' selection bladder capacity was considered. In all 30 patients autoaugmentation with removal of detrusor to half of height of the bladder and bilateral psoas hitch maneuver were carried out. Autoaugmentation was performed simultaneously with sling procedure in 3 girls and with closure of the bladder neck with creation of continent reservoir in 1 boy. 3 other patients have undergone construction of continent urinary stomas without closure of the bladder neck and in 2 of them additional continent appendicocaecostomy due to constipation and soiling was done.
Results. Patients' follow-up ranged from 2 to 12 years. In postoperative urodynamic studies inravesical pressure ranged from min 15 cm H2O to max 80 cm H2O (median 39.7) and bladder capacity from 70 to 400 ml (median 264.8). Vesico-ureteral reflux decreased in 5 and disappeared in 3 patients. 2 patients, out of 5 in whom the degree of reflux decreased, required surgical inervention as teflon injection. In 5 patients deterioration of upper urinary tract with persistent massive reflux in 4 of them was observed. In 4 patients with deterioration of upper urinary tract increase of bladder capacity was not achieved. All of these patients were qualified to other methods of bladder augmentation such as ileocystoplasty, colocystoplasty or ureterocystoplasty. In 1 patient with renal insufficiency decrease of high intravesical pressure, but without increase of bladder capacity was found. This patient also was qualified to bladder augmenation with use of ileal patches before renal transplant.
Conclusions. 1. Autoaugmenation is successful method in lowering intravesical pressure. 2. The method does not guarantee adequate enlargement of bladder capacity and should be consider in patients with bladder capacity above 100-200 ml. 3. Autoaugmenation is not a method useful for patients with end renal insufficiency because enlargement of bladder capacity is temporary and decreases with time as urine production. 4. Long time observations show that the bladder capacity does not decrease in normal renal function. 5. Non successful autoaugmentation does not eliminate other methods of bladder augmentation. 6. This method avoids all complications in connection with using of bowel patches and this is its biggest advantage.