URETERAL BLADDER AUGMENTATION

Virtually all segments of the gastrointestinal tract have been used su ccessfully in augmentation cystoplasty. The complications inherent in enterocystoplasty are well described. Megaureters subtending effete ki dneys (poorly or nonfunctioning) provide a novel and excellent source of augmentation material with urothelium and muscular backing, free of the electrolyte and acid base disturbances, and mucus production that plague enterocystoplasty. Augmentation cystoplasty using detubularize d, reconfigured, otherwise disposable megaureter, with or without ipsi lateral total or partial nephrectomy, was performed in 16 patients (me an age 8.8 years, range 1 to 25) with inadequate and dysfunctional bla dders. Postoperative followup varied between 8 and 38 months (mean 22) . The overall renal function and radiographic appearance of the remain ing upper tracts have remained stable or improved in all patients. Of the 16 patients 15 require intermittent catheterization and 1 voids sp ontaneously. Ten patients are continent day and night, 5 have improved continence (4 damp at night and 1 stress incontinence) and 1 has fail ed to gain continence despite good capacity and compliance. Complete p ostoperative urodynamic evaluations in 12 of 13 patients show good cap acity, low pressure bladders with no instability. Complications occurr ed in 5 patients, including transient urine extravasation in 2, contra lateral ureterovesical obstruction in 2 and Mitrofanoff stomal stenosi s in 1. Augmentation ureterocystoplasty combines the benefits common t o all enterocystoplasties without adding any of the untoward complicat ions or risks associated with nonurothelial augmentations.