THE EFFECT OF GASTRIC AUGMENTATION ON BLADDER FUNCTION

Gastrocystoplasty was performed in 29 female and 14 male patients 1 to 23 years old (average age 11 years). Urodynamic studies were complete d in 20 patients preoperatively and within 6 months postoperatively. W hen postoperative studies were compared with the preoperative evaluati on, it was noted that overall capacity increased an average of 220% (r ange 20 to 750%). Compliance also improved dramatically postoperativel y. Bladder pressures increased from a mean volume of 34% of capacity p reoperatively to 73% of the post-augment capacity. The average maximum filling pressure decreased by 32%, from 57 to 39 cm. water. Uninhibit ed contractions resolved completely in 6 of 10 patients who had them p reoperatively. No one had uninhibited contractions postoperatively. Cy clical contractions of the stomach segment not exceeding 50 cm. water developed in 6 patients. The gastric patch seems to be an adequate sou rce for improving the dynamics of a poorly functioning detrusor muscle in most patients. When a diamond-shaped patch of stomach is harvested and added to the bladder a spherical configuration is created, enhanc ing the storage properties. This result is in sharp contrast to other bowel segments, which must be detubularized to produce a suitable rese rvoir. The long-term effects of gastric augmentation remain to be dete rmined.