Sparing ureterocystoplasty; a method of bladder augmentation in myelomeningocele patients
Article published in Urologia Polska 2002/55/4.

authors

Marek Orkiszewski, Jarosław Leszniewski, Joanna Madej: Katedra i Klinika Chirurgii Dziecięcej i Traumatologii Akademii Medycznej w Bydgoszczy Wojewódzki Szpital Dziecięcy w Toruniu Kierownik kliniki: dr hab. Marek Orkiszewski

keywords

bladder, neurogenic dysfunction, ureterocystoplasty

summary

The ureter is regarded as the best material for bladder augmentation. However, only patients with nonfunctioning kidney and rnegaureter are suitable candidates for ureterocystoplasty. The ureteric graft decreases intravescial pressure and increases bladder capacity. In order to prevent injury to blood supply to the most distal ureter, this part is left intact. Although the number of presented patients is small, every new experience adds to clinical knowledge and is thus instructive.

Material. In 2 meningomyeocele patients with hydrocephalus in whom one kidney did not function with ipsilateral rnegaureter, the bladder was augmented with a longitudinally incised ureter. The most distal 2 cm long fragment of the ureter was left intact. Bladder capacity was measured prior to augmentation and 12 months after the operation. Compliance of the bladder was assessed in urodynamics. Frequency of urinary tract infections was estimated.

Results. During the 12 months after the operation bladder compliance increased over 100% in patient 1, and over threefold in patient 2. Intravescial pressure decreased to about 66 cm HiO in patient I and to 27 cm H2O in patient 2. Bladder wall compliance rose 85% in patient 1 and over 600% in patient 2. In both patients the frequency of urinary tract infections has decreased. Conclusions:

1. Sparing ureterocystoplasty is a relatively simple safe method for preserving the ureter blood supply.

2. The bladder becomes a good low-pressure reservoir after augmentation.

3. The technique makes it possible to increase significantly bladder capacity.

references

1. Duel BIJ Gonzales R, Barthold JS:Alternative techniques for augmentation cystoplasty. J Urol 1998; 159: 998-1005.
2. Landau EH, Jayanalhi VK, Khoury AE, Churchill BM, Gilmour RF, Steckler RE, McLorie GA: Bladder augmentation; weterocy-stopiasty versus ileoa\\\'stoplasty. J Urol 1994; 152:716-719.
3. Bellinger MF: Ureterocystoplasty: a unique method for vesical augmentation in children. J Urol 1993; 149: 811-815.
4. Churchill BM, Aliabadi H, Landau EH, McLorie GA, Steckler RE, McKcnna PH, Khoury AE: Ureteral bladder augmentation. J Urol 1993; 150: 716-721.
5. Wolf JS, Jr. Tuizan CW: Augmentation ureterocystoplasty. J Urol 1993; 149:1095-1098.
6. Adams MC, Brock JW III, Pope JC, Rink RC: Ureterocystoplasty: is it necessary to detubularize the distal umler? J Urol 1998; 160:851-853.
7. Skobejko-Wlodarska L, Czyż J, Srrulak K, Gastol P, Baka-Ostrowska M, Wolski J, Śmigielski M, Kowalczyk K Augmentation ureterocystoplasty in myelodysplastic children. SurgChildh Intern 2001; 9:125-128.
g. Zubicta R, de Badiola E Escala J M, Castellan M, Puigdcvall JC, Ramirez K, Ramirez R, Ruiz E: Clinical and urodynamics evaluation after ureterocystoplasty with different amounts of tissue. J Urol 1999;162:1129-1132.
9. Perovic SV, Vukadinovic VM, Djordevic U: Augmentation ureterocystoplasty could be peifonned more frequently. J Urol 2000; 164: 924-927.

correspondence