AUGMENTATION CYSTOPLASTY IN BOYS WITH POSTERIOR URETHRAL VALVES

The role of augmentation cystoplasty in the neuropathic and exstrophy bladder has been well documented. However, its place and the timing of such surgery in the ''valve bladder'' are not well established. We re port our experience with augmentation cystoplasty in 20 boys with prev iously treated posterior urethral valves. Urodynamic studies confirmed poorly compliant, unstable bladders with low functional capacities, w hich had failed to respond to anticholinergic treatment in all patient s. The bladder was augmented with ileum in 9 cases, stomach in 7, colo n in 2 and ureter in 2. A Mitrofanoff channel was fashioned in 6 cases . Upper tract dilatation improved in 17 patients and remained stable i n 3. Of the patients 17 are dry day and night. Eleven patients void sp ontaneously without significant residual urine, 7 are on clean intermi ttent catheterization for residual urine of greater than 50 ml. and 2 are completely dependent on catheterization. Augmentation cystoplasty is a safe and effective method to achieve continence with a low capaci ty, poorly compliant bladder in children with posterior urethral valve s who do not respond to medical management. In contrast to the neuropa thic and exstrophy bladder, the augmented valve bladder allows spontan eous voiding without significant residual urine in the majority of cas es. Early intervention in these patients may prevent deterioration in renal function.