BLADDER AUGMENTATION - URETEROCYSTOPLASTY VERSUS ILEOCYSTOPLASTY

The primary advantages of augmentation ureterocystoplasty include the absence of mucus, lack of electrolyte absorption from the augmenting s egment and the avoidance of gastrointestinal complications. We tested whether the ureteral patch offers sufficient biomaterial to increase a dequately the storage efficiency of dysfunctional bladders. Between Ap ril 1989 and November 1992, 8 children with unilaterally dilated and t ortuous ureters underwent bladder augmentation using detubularized rec onfigured megaureter. Clinical and urodynamic outcomes were compared b etween these patients and a control group of 8 children matched in age and diagnosis who had undergone ileocystoplasty during the same time. Total bladder capacity, pressure specific bladder volume at pressure less than 30 cm. water, dynamic analysis of bladder compliance, contin ence and upper tract status were compared between the 2 groups before and after augmentation. Preoperatively, all 16 patients were incontine nt with high pressure, small capacity bladders, and all had upper trac t changes. Postoperatively, the mean total bladder capacity was 417 ml . in the ureterocystoplasty group and 381 ml. in the ileocystoplasty g roup (p > 0.05), while the mean pressure specific bladder volume was 4 13 and 380 mi. (p > 0.05), respectively. Pressure specific bladder vol ume and dynamic bladder compliance were normal in 7 of 8 patients (87. 5%) in the ureterocystoplasty group. All patients in the ileocystoplas ty group had normal postoperative urodynamics. We conclude that megaur eters subtending effete kidneys may be used to improve the storage fun ction of dysfunctional bladders to the same extent as that achieved wi th ileum without the complications pursuant to ileocystoplasty, and th at the improvement is maintained long term.