Bladder augmentation: Urodynamic findings and clinical outcome in different augmentation techniques

Objective: To compare the urodynamic findings and clinical outcome in diffe rent bladder augmentation techniques. Patients and methods: From 1987 to 1996, 32 bladder augmentations were perf ormed in 30 (M:F/18:12) patients. Mean age was 8.1 years (range: 1-15 years ) and the mean follow-up period was 3.2 years (range: 6 months to 8 years). The following techniques were used for bladder augmentation: sigmoid colon in eleven cases, stomach in nine cases, ileum in six cases, ileocaecum in two cases and rectus abdominis muscle flap (RAMF) in four cases. Seven pati ents also underwent Mitrofanoff procedure to create a continent stoma. Results: According to the urodynamic evaluation the mean capacity was 237 /- 720 ml in the colonic group, 175 +/- 86 ml in the gastric group, 240 +/- 45 ml in the ileal group, 250 +/- 0 ml in the ileocaecal group and 30 +/- 10 ml in the RAMF group. The mean compliance was 20.6 +/- 14 ml/cm H2O in t he colonic group, 10.7 +/- 10.4 ml/cm H2O in the gastric group, 21.6 +/- 9 ml/cm H2O in the ileal group, 25.5 +/- 5.5 ml/cm H2O in the ileocaecal grou p, 5.8 +/- 1.5 ml/cm H2O in the RAMF group. The upper urinary tract was nor mal without hydronephrosis in all but except two patients. These two patien ts are still treated medically for chronic renal failure by the pediatric n ephrology team. The patients are using their Mitrofanoff or native urethra with clean intermittent catheterization (CIC) OF self-CIC technique for con tinence. Conclusion: Comparing these five different techniques, ileal, ileocaecal an d colonic groups were in advantage to achieve high volume reservoirs, follo wed by the gastric group. Regarding complications; in colonic cases, mucus problems, stone formation and surgical complications related to gastrointes tinal tract (intestinal obstruction, perforation) were the most common ones . Perineal dermatitis was the main complication in gastric cases. In the il eal group, complication rate was low. Absence of mucus production and the l ow postoperative complication rates were the two major advantages of RAMF t echnique. However this technique is not recommended as an augmentation proc edure due to its low capacity and compliance rates. Recently, ileal augment ation has became the most popular method in our institution.