RESULTS OF URINARY-TRACT RECONSTRUCTION IN BOYS WITH END-STAGE BLADDERS RESULTING FROM OBSTRUCTIVE UROPATHY

Purpose: The records of 17 boys who underwent reconstruction of the lo wer urinary tract because of end stage bladders resulting from obstruc tive uropathy were reviewed to evaluate the degree to which they void and factors that favorably impacted outcome, Materials and Methods: A total of 17 boys with, end stage bladders resulting from obstructive u ropathy, including posterior urethral valves in 15 and obstructing ure teroceles in 2, underwent reconstruction of the urinary tract. Procedu res consisted of augmentation (autoaugmentation in 3, ileocystoplasty in 2, ileocecal cystoplasty in 1 and colocystoplasty in 10), an ileal ureter in 2, bladder neck revision in 15 and appendicovesicostomy in 8 . Results: All patients achieved a low pressure reservoir of adequate volume with stable or improved urinary tracts. A total of 13 patients voided sufficiently well to maintain a favorable life-style, including 5 who were completely catheter-free. With respect to the variables in volved in reconstruction, bladder neck revision seemed. to correlate b est with a good outcome. Conclusions: in most cases end stage bladders in boys with obstructive uropathy can be reconstructed not only to pr otect the urinary system, but to preserve some degree of voiding poten tial as well, Bladder neck revision appears to be particularly helpful in achieving the latter goal. When voiding is inadequate, appendicove sicostomy provides easy access to the bladder for intermittent cathete rization.