Ureterocystoplasty: An Ideal Method for Vesical Augmentation in Children

Abstract

Background: Inadequate therapy endangers upper urinary tract function in children with low compliance bladders. We report our approach of increasing bladder compliance using the patients own (mega)-ureter for bladder augmentation. Patients: A total of 8 children underwent ureterocystoplasty. The etiology of bladder non-compliance and the need for augmentation was neurogenic in 5 children, posterior urethral valves in 2 children and in one child the situation after ­repeated antireflux surgery. In all patients the kidney of the used ureter was functionless. Surgery was done through a transperitoneal approach. After nephrectomy, the renal pelvis and the ureter were spatulated and sutured into the bladder incision. An additional MACE stoma was made in 3 patients, antireflux surgery for the contralateral kidney was necessary in 2 patients and one patient underwent stone removal in the remaining kidney. In 1 patient the ureter was used as a free transplant and was covered by an omental flap. In addition, a simultaneous living donor kidney transplant was performed (case 2). Results: Bladder capacity and compliance improved significantly in all patients. The function of the ureter which was used as a free transplant showed good clinical results. The longest follow-up is 8 years. Conclusion: Ureterocystoplasty is a useful and metabolically neutral alternative to bowel segments. In patients with only one functioning ­kidney and a contralateral megaureter, ureterocystoplasty is the treatment of choice in our institution.

Key words

ureterocystoplasty - bladder augmentation - ureter

References

• 1 Bellinger M F. Ureterocystoplasty update.  World J Urol. 1998;  16 251-254
• 2 Bellinger M F. Ureterocystoplasty: a unique method for vesical augmentation in children.  J Urol. 1993;  149 811-813
• 3 Carneiro P M, Binyamini J, Sofer M et al. Augmentation ureterocystoplasty: is it the preferred choice?.  East Afr Med J. 2005;  82 247-249
• 4 Cartwright P C, Snow B W. Bladder autoaugmentation: early clinical ­experience.  J Urol. 1989;  142 505-508 ,  discussion 520–501
• 5 Churchill B M, Aliabadi H, Landau E H et al. Ureteral bladder augmentation.  J Urol. 1993;  150 716-720
• 6 Eckstein H BMM. Uretero-Cystoplastik.  Aktuel Urol. 1973;  4 255-277
• 7 Gilbert S M, Hensle T W. Metabolic consequences and long-term complications of enterocystoplasty in children: a review.  J Urol. 2005;  173 1080-1086
• 8 Gurocak S, De Gier R PE, Feitz W. Bladder augmentation without integration of intact bowel segments: critical review and future perspectives.  The Journal of Urology. 2007;  177 839-844
• 9 Haferkamp A, Melchior D, Schumacher S et al. [Ureterocystoplasty: functional results and possible problem areas].  Urologe A. 2003;  42 954-959
• 10 Hinman F. Atlas of Urosurgical Anatomy. Oxford: W. B. Saunders; 1993
• 11 Husmann D A, Snodgrass W T, Koyle M A et al. Ureterocystoplasty: indications for a successful augmentation.  J Urol. 2004;  171 376-380
• 12 Mills R D, Studer U E. Metabolic consequences of continent urinary ­diversion.  J Urol. 1999;  161 1057-1066
• 13 Mitchell M E. Bladder augmentation in children: where have we been and where are we going?.  BJU Int. 2003;  92 Suppl 1 29-34
• 14 Pascual L A, Sentagne L M, Vega-Perugorria J M et al. Single distal ureter for ureterocystoplasty: a safe first choice tissue for bladder augmentation.  J Urol. 2001;  165 2256-2258
• 15 Perovic S V, Djordjevic M L, Kekic Z K et al. Bladder autoaugmentation with rectus muscle backing.  J Urol. 2002;  168 1877-1880
• 16 Perovic S V, Djordjevic M L, Kekic Z K et al. Detrusorectomy with rectus muscle hitch and backing.  J Pediatr Surg. 2003;  38 1637-1641
• 17 Podesta M, Barros D, Herrera M et al. Ureterocystoplasty: videouro­dynamic assessment.  J Urol. 2006;  176 1721-1725
• 18 Wolf Jr J S, Turzan C W. Augmentation ureterocystoplasty.  J Urol. 1993;  149 1095-1098
• 19 Zubieta R, de Badiola F, Escala J M et al. Clinical and urodynamic evaluation after ureterocystoplasty with different amounts of tissue.  J Urol. 1999;  162 1129-1132