Autoaugmentation (detrusotomia) - still an effective option or an outdated method of high pressure neuropathic bladder treatment?
Article published in Urologia Polska 2006/59/4.

authors

Lidia Skobejko-Włodarska, Karina Felberg, Piotr Gastoł, Małgorzata Baka-Ostrowska: Klinika Urologii Dziecięcej, Instytut "Pomnik - Centrum Zdrowia Dziecka" w Warszawie

keywords

neuropathic bladder, high intravesical pressure, small bladder capacity, autoaugmentation

summary

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 aged 1 to 18. In 19 patients, dilatation of upper urinary tract was stated, and among 8 of them the development of hydroureteronephrosis was observed. Urodynamic study showed high intravesical pressure from 45 to 182 cm H2O and bladder capacity from 66 to 350 ml.

Results. Patients' follow-up ranged from 2 to 12 years. Improvement of upper urinary tract was observed in majority of patients. Only 5 demonstrated mild dilatation and one hydroureteronephrosis. In postoperative urodynamic studies inravesical pressure decreased on the average about 50 cm H2O and bladder capacity increased on the average about 118 ml. In 6 patients good results of autoaugmentation cystoplasty were not achieved. All of them were qualified to other methods of bladder augmentation.

Conclusions. Autoaugmenation helps avoiding all complications connected with the use of bowel patches. This is a successful method in lowering intravesical pressure and it should be recommended only with this end in view. The method does not guarantee adequate enlargement of bladder capacity and should be considered in patients with bladder capacity above 200 ml. Autoaugmenation is not a useful method for patients with end stage renal insufficiency because enlargement of bladder capacity is temporary and decreases with the loss of urine production. Long time observations show that the bladder capacity does not decrease in patients with normal renal function. Unsuccessful autoaugmentation does not eliminate other methods of bladder augmentation.

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correspondence