PTU - Polskie Towarzystwo Urologiczne
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Usefulness autoaugmentation in the treatment of a neurogenic bladder in children
Article published in Urologia Polska 2001/54/4.

authors

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

keywords

ladder, neurogenic bladder, high intravesical pressure, autoaugmentation

summary

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.

references

  1. 1. Hendren, WH, Hendrcn, RB: Bladder augmentation: experience with 129 children and young adulls. J Uroi, 1990, 144, 445-453.
  2. 2. Singh O, Thomas DG: Enterocystoplasty in the neuropathic bladder. Neurourol Urodyn, 1995, 14, No 1, 5-10.
  3. 3. Cartwright, PC, Snow, B. W: Bladder autoaugmentaiion: Early clinical experience. J Urol, 1989, 142, 505-508.
  4. 4. Cartwright PC, Snow BW: Bladder augmentation: Partial detrusor excision to augment the bladder without use of bowel. J Urol 1989,142,1050-1053.
  5. 5. Elicevik M, Celayir S, Dervisoglu S, Buyukunal SNC: Comparison of different bladder autoaugmenlation techniques in a rabbit model. BJU 1998, 81, 49-54.
  6. 6. Snow BW, Cartwright MD: Bladder autoaugmenlation. Urol Clin North Am, 1996, 23, 323-331.
  7. 7. Stohrer M, Kramer A, Goepel M, Lochner-Ernst D, Kruse D, Rubben H: Bladder autoaugmenlation - an alternative for enlerocystoplasty: preliminary results. Neurourol. Urodyn 14, No 1, 11-23.
  8. 8. Stothers L, Johnson H, Arnold W, Coleman G, Tearle H: Bladder autoaugmenlation by vesicomyotomy in the pediatric neurogenic bladder. Urology 1994, 44, 110-113.
  9. 9. Swami KS, Feneley RCL, Hammonds JC, Abrams P: Detrusor myectomy for detrusor overactivity: a minimum 1-year follow-up. BJU 1998, 81, 68-72.
  10. 10. Filmcr R, Spencer JA: Malignancies in bladder augmentation and intestinal conduits. J Urol 1990, 143, 671-678.
  11. 11. Koch MO, McDougal WS: The pathophysiology of hyperchlore-mic metabolic acidosis after uiinaiy diversion through intestinal segments. Surgery 1985, 98, 561-570.
  12. 12. Smith P, Hardy GT: Carcinoma occuring as a late complication ofileocystoplasty. BJU 1971, 43, 576-579.
  13. 13. Skobejko-Wlodarska L, Strulak K, Nachulewicz P, Szymkiewicz C\\\': Bladder autoaugmenlation in myelodysplastic children BJU 1998, 81, Suppl. 3, 114-116.
  14. 14. Skobejko-Wlodarska L, Strulak K, Nachulewicz P, Szymkiewicz C: Autoaugmenlation of neurogenic bladder. Surgery in Childhood International 1998, VI, No 1, 44-47.

correspondence

Udia Skobejko-Wlodarska
ul. Kossakowskiego 37 A
04-744 Warszawa
telifax (0-22) 8I5 62 67