Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20-year review.

BACKGROUND: The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. METHODS: Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999-2019). Short- and long-term outcomes and complications following augmentation cystoplasty were defined. RESULTS: Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy-epispadias complex (30%) and posterior urethral valves (23%). The most common tissue-type utilized was ileal (58%) and ureteric (30%). Peri-operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end-of-study detrusor pressure improved significantly following bladder augmentation (38-17 cmH2 O, P < 0.001). Bladder capacity improved significantly (67-89%, P = 0.041). The median follow-up was 4.5 years (interquartile range: 1.9-10 years). Bladder urolithiasis affected 13 (18%) patients, and symptomatic urinary tract infections 36 (51%) patients. Formation of a continent catheterisable channel contributed a number of complications relating predominantly to stenosis (50%). Repeat augmentation cystoplasty was necessary in three (4%) cases. CONCLUSION: Augmentation cystoplasty is a surgical intervention that improves bladder metrics. Given the potential complications, careful patient selection and appropriate pre-operative counselling are essential. Furthermore, pro-active post-operative management and transitional care are vital in the surgical care of children following augmentation cystoplasty.

Retroperitoneoscopic bilateral nephrectomy and extraperitoneal ureterocystoplasty in a child on peritoneal dialysis.

A 4-year-old boy with posterior urethral valves and end stage kidney disease on peritoneal dialysis presented with high pressure non-compliant bladder with left ureterohydronephrosis. Inability to perform hemodialysis due to patient's weight exclusion, imposed the necessity to preserve peritoneal dialysis. A bilateral nephrectomy by retroperitoneoscopy with extraperitoneal augmentation ureterocystoplasty using left ureter and pelvis associated with continent diversion using right ureter as umbilical stoma was performed followed by kidney transplantation. An excellent outcome with voluntary voiding without CIC is reported eighteen months later. This treatment modality is the best option to manage End Stage Kidney Disease on peritoneal dialysis in those patients.

Ureterocystoplasty (bladder augmentation) in a 16 year-old boy with Goldenhar syndrome.

The use of the dilated ureter for bladder augmentation is universally accepted for its lower rate of complications compared to the use of gastrointestinal segments. We report the case of a 16 yearold boy affected by Goldenhar syndrome who presented with neurogenic bladder with small-capacity, 5° grade vescico-ureteral reflux (VUR) with megaureter and bilateral hydronephrosis. Bladder augmentation using the distal dilated ureter, transuretero-ureterostomy left to right and Mitrofanoff's appendicovescicostomy were performed. Six months after surgery voiding cystourethrogram (VCUG) revealed a compliant bladder with a functional capacity of 400 ml. Ureterocystoplasty is a safe and effective method of augmenting small capacity urinary bladder. We suggest using the ureter, when available, instead of using gastrointestinal segments.

Alternatives to conventional enterocystoplasty in children: a critical review of urodynamic outcomes.

Alternatives to conventional enterocystoplasty have been developed in order to avoid the most common complications derived from contact of the urine with intestinal mucosa. In this article critically we review the literature on the topics: ureterocystoplasty, detrusorectomy, detrusorotomy, seromuscular gastroenterocystoplasty, use of off the shelf biomaterials, and bladder augmentation by bioengineering. Recognizing the difficulty of deciding when a child with a history of posterior urethral valves requires and augmentation and that the development of a large megaureter in cases of neurogenic dysfunction represents a failure of initial treatment, we conclude that ureterocystoplasty can be useful in selected cases when a large dilated ureter is available. Seromuscular colocystoplasty lined with urothelium (SCLU) has been urodynamically effective in several series when the outlet resistance is high and no additional intravesical procedures are necessary. Seromuscular gastrocystoplasty lined with urothelium seems to offer no distinct advantages and involves a much more involved operation. The use of seromuscular segments without urothelial preservation, with or without the use of an intravesical balloon has been reported as successful in two centers but strict urodynamic evidence of its effectiveness is lacking. The published evidence argues strongly against the use of detrusorectomy or detrusorotomy alone because of the lack of significant urodynamic benefits. Two recent reports discourage the use of small intestinal submucosa patches because of a high failure rate. Finally, research into the development of a bioengineered bladder constructed with cell harvested from the same patient continues but is fraught with technical and conceptual problems. In conclusion of the methods reviewed, only ureterocystoplasty and SCLU have been proven urodynamically effective and reproducible.

Ureterocystoplasty in pediatric patients with unilateral nonfunctioning kidney.

OBJECTIVE: Bladder augmentation with uroepithelium lined material yields an absence of mucus production, with reduced possibility of urinary infection and lithiasis. The utilization of the ureter in augmentation cystoplasty results in a uroepithelium-lined neobladder with all of the appropriate histologic layers. The purpose of this study was to assess the efficacy and safety of ureterocystoplasty in children with a small bladder capacity and low bladder compliance. MATERIAL AND METHODS: Between January 1992 and August 2011, six females and eight males who were 3 to 13 years old (median age 6 years) and had a low-capacity, poorly compliant bladder underwent augmentation cystoplasty using dilated ureters. Unilateral non-functioning renal moiety draining into a massively dilated ureter was present in every patient. The etiology of hydroureteronephrosis was a neurogenic bladder secondary to meningomyelocele in five patients, a posterior urethral valve in four patients, an obstructive megaureter in three patients and ectopic obstructive ureterocele in two patients. RESULTS: Mean age was 6 years (3-13 y). Clinical improvement regarding the resolution of reflux, a better bladder capacity and improved compliance was achieved in every patient. The increase in bladder capacity ranged from 84 cc (30 to 200) to 235 cc (150 to 420), with a mean increase of 318% (210 to 500). Marked improvement in compliance was also observed (from 1.2 to 5.1 mL/cm H2O, mean 2.4, to 22 to 50 mL/cm H2O, mean 41). No uninhibited bladder contractions were detected during a urodynamic study at 12 months postoperatively. CONCLUSION: In patients with a low-capacity, poorly compliant bladder, augmentation cystoplasty using the ureter seems to be a viable alternative. Ureterocystoplasty results in a large-capacity, high-compliance bladder, without metabolic and infective complications, compared with other techniques of augmentation cystoplasty.

Bladder augmentation: Distal ureterocystoplasty with proximal ureteric reimplantation: A novel technique.

A novel technique of bladder augmentation is reported, wherein the distal dilated ends of tortuous ureters were used for ureterocystoplasty while proximal remaining ureters reimplanted back into the native bladder.

MONTI as continent catheterized stoma using serosal-lined trough "Ghoneim Abolenin" technique in ileocystoplasty.

It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.

Comparison of Enterocystoplasty and Ureterocystoplasty before Kidney Transplantation.

BACKGROUND: Augmentation cystoplasty before or after renal transplantation is an option for patients with end-stage renal disease who are candidates for renal transplantation and have low capacity and poorly compliant bladders. OBJECTIVE: To compare two surgical methods of bladder augmentation-enterocystoplasty (EC) and ureterocystoplasty (UC)-before kidney transplantation, and their outcome with that in kidney recipients who had normal bladder function. METHODS: During a 20-year period (1988-2008), 1406 renal transplantation were performed in our center by our team. In 16 patients having a mean age of 18.8 years, EC (group A) and in 8 with mean age of 11.5 years, UC (group B) were performed before renal transplantation. These two groups were compared with a control group of 30 recipients with normal bladder (group C) with mean age of 15.6 years, for kidney function, graft and patient survival, and the frequency of urinary tract infection (UTI). RESULTS: There was normal graft function in 11 of group A, 7 of group B, and 24 of group C patients, during a mean follow-up of 73.1 months. The mean±SD serum creatinine in follow-up was 1.72±0.31, 1.37±0.13 and 1.33±0.59 mg/dL in groups A, B and C, respectively. No statistically significant differences were observed among the 3 studied groups in terms of 1-, 5- and 10-year graft and patient survivals. Number of episodes of febrile UTI requiring hospitalization was 23, 6 and 2 in groups A, B and C, respectively. UTI and urosepsis were significantly more frequent in group A than groups B (p=0.025) and C (p=0.001); no significant difference was observed in the frequency between groups B and C (p=0.310). CONCLUSION: Both EC and UC are equally recommended before renal transplantation for reconstruction of the lower urinary tract; use of each method should be individualized depending on specific conditions of recipient.

Implante uretero-vesical em ratos

Apresentar os resultados obtidos com técnica de implante ureterovesical em ratos após obstrução ureteral ipsilateral. Treze ratos foram submetidos à obstrução ureteral distal à direita e, após uma semana, realizou-se o implante desse ureter na bexiga seguido da nefrectomia contralateral. No período de observação de 4 semanas foram estudados os níveis séricos semanais de uréia e creatinina e, na quarta semana, foi realizada cistografia para pesquisa de refluxo vésico-ureteral. Nove animais sobreviveram ao período de obstrução ureteral. Observou-se aumento significativo dos valores de uréia e creatinina sérica no segundo dia pós-operatório, que regrediram para níveis semelhantes aos basais já na terceira semana de seguimento. Não foi observado refluxo vésico-ureteral à cistografia. Após o sacrifício, a avaliação da junção uretero-vesical não mostrava sinais de obstrução, havendo regressão da hidronefrose presente antes do implante ureteral. A técnica de reimplante ureteral utilizada é eficaz em proporcionar adequada drenagem do trato urinário, evitando refluxovésico-ureteral, sendo adequada para ser utilizada no estudo da recuperação da função renal após período de obstrução ureteral.

A pelvic kidney and a contralateral incomplete double collecting system with associated bilateral ectopic obstructive megaureters

A two-month old female child presenting with recurrent febrile urinary tract infection (UTI) was diagnosed to have a single-system pelvic kidney and a contralateral incomplete ureteral duplication with associated bilateral ectopic obstructive megaureters draining into the proximal urethra. Bilateral cutaneous loop ureterostomy was done at that time. Subsequently, she underwent undiversion, transuretero-pyelostomy (double left ureters to right pelvis), right ureteroneocystostomy, and augmentation ureterocystoplasty. Biopsy of the right distal ureter was consistent with megaureter with acute and chronic ureteritis. Repeat IVP post-op showed well-opacified kidneys with no signs of obstruction and a well-distended urinary bladder with moderate post-void residual urine. A high index of suspicion, coupled with meticulous physical examination and rationally combined diagnostic procedures are important to make a diagnosis of a unique combination of rare congenital urologic anomalies. (Author)

Ureterocystoplasty: Experiences in Two Cases of Posterior Urethral Valve / 대한비뇨기과학회지

Ureterocystoplasty is a known useful method for the management of selected cases with dilated ureters, high pressure and poorly compliant bladders. It precludes the potential complications of enterocystoplasty. In two cases of posterior urethral valve with urinary incontinence, bilateral dilated ureters, and poorly compliant bladders, we performed ureterocystoplasties using dilated lower end of the ureter after transuretero-ureterostomy and ureteral reimplantation. Both patients were almost continent day and night. The bladder capacities and compliances were improved. There was no deterioration of renal functions. In conclusion, we suggest that the ureterocystoplasty using dilated distal ureter after transureteroureterostomy is an appropriate procedure in selected cases of posterior urethral valve.