Usefulness autoaugmentation in the treatment of a neurogenic bladder in children
Article published in Urologia Polska 2001/54/4.
Lidia Skobejko-Włodarska, Jerzy Czyż, Piotr Gastoł, Jan Karol Wolski, Mieczysław Śmigielski, Krystyna Strulak, Małgorzata Baka-Ostrowska
- Klinika Urologii Dziecięcej Instytutu "Pomnika Centrum Zdrowia Dziecka" w Warszawie Kierownik kliniki: dr hab. Małgorzata Baka-Ostrowska
ladder, neurogenic bladder, high intravesical pressure, autoaugmentation
- Objective. To discuss advanteges and disadvantages of autoaugmentation and report long-term results of this method.
- Material and method. 27 children wilh high pressure neurogenic bladder after meningocoele repair from 1 to 18 years old have undergone autoaugmentation. 7 patients had failed earlier treatments by intermittent cathelerisation (CIC) and anticholinergic agents. The upper urinary tract was dileled in twenty children. One patient showed agenesis of one kidney. 1 child suffered from renal insufficiency and one had high urine production above 6 litre on day. Massive vesico-ureteral refluxes were diagnosed in 12 cases. 16 patients were dry for only 2 hours periods on CIC.
- Results. Patients follow up ranged from one to eight years. Of these 27 patients after autoaugmentation procedure 25 were controlled postoperatively urodynamically and by estimating condition of the upper and lower urinary tract. The upper urinary trad showed improvement in 15 cases (Table I). In 6 patients reflux was disappeared, in one child reflux was diminished (Table I). 12 children improved continence and have been dry for 3-4 hours periods. Bladder capacity increased and intravesical pressure decreased to 40 cm H20 in 12 cases. Of these children one (L. M. •) have undergone vesicostomy (Table I). Bladder capacity increased and intravesical pressure decreased to 60 cm H20 in 5 cases. In one of them (O. S. *) have undergone ileocystoplasty (Table I). In 5 children who had unsuccessful augmentation of the bladder capacity, intravesical pressure decreased. Three of them required enterocystoplasty (Table I). 3 patients showed no change in bladder capacity and in high intravesical pressure. Conclusions:
- 1. Autoaugmentation allows limiting the extent of the surgical procedure to only the extraperitoneal space and keeps open all of the other options of bladder augmentation,
- 2. This method is a resonable alternative to enterocystoplasty.
- Bladder autoaugmentation is not successful method in children with neurogenic bladder dysfunction and renal insufficiency.
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