CONTINENT GASTRIC POUCH

Between January 1985 and June 1995 a total of 12 patients (9 female, 3 male) underwent total reconstruction of the lower urinary tract using gastric tissue. Their mean age was 10 years (range, 5-25 years). Tota l gastric bladder substitution was performed in seven patients whereas five other patients had composite continent reservoirs (stomach plus bowel) created. The diagnoses were cloacal exstrophy, classic bladder exstrophy, bladder rhabdomyosarcoma, bilateral ectopic ureters, and VA CTERL association. The mean follow-up period was 4.5 years (range, 16 months to 9 years). The average bladder capacity was 309 ml, and the c ompliance averaged 12.9 ml/cmH(2)O. Continence was achieved in all pat ients, but the continence mechanism often required revision. Renal det erioration was noted only in one patient due to an obstruction at the site of a transureteroureterostomy. The complications included hyponat remic, hypochloremic metabolic alkalosis (two patients); prolapse of t he neovagina (one patient); a ureterovesical junction obstruction (thr ee patients); and revision of the neourethra or Mitrofanoff (six patie nts). Revision of the gastric tube used as the catheterizable channel was performed in three instances. Lengthening of the tube, including n ippling in one instance, corrected persistent incontinence. Distal ste nosis of a gastric tube required several plastic procedures for correc tion. A ureteral Mitrofanoff developed a distal stricture necessitatin g revision. Persistent leaking of an appendiceal Mitrofanoff was corre cted with reimplantation. A tapered ileal neourethra required a tunnel ing procedure followed by Teflon injection to provide urinary continen ce. Complications seen most often involved the continence mechanism of these gastric neobladders or composite urinary reservoirs. Persistenc e, patience, and perseverance led to total urinary continence and adeq uate reservoirs for urine storage in all patients.