FUNCTIONAL OUTCOME AND SPECIFIC COMPLICATIONS OF GASTROCYSTOPLASTY FOR FAILED BLADDER EXSTROPHY CLOSURE

Purpose: The encouraging initial results of gastrocystoplasty led us t o perform it for failed bladder exstrophy closure. We assess the funct ional outcome of the augmented bladder and evaluate complications rela ted directly to use of the stomach in this specific group of children. Materials and Methods: We performed gastrocystoplasty in 22 children an average of 9.5 years old with a small, poorly compliant bladder aft er staged reconstruction of bladder exstrophy failed. Followup ranged from 6 months to 6 years (mean 3 years). Results: Complete urinary con tinence was achieved in 14 children (64%). Voiding via the urethra was possible in 13 patients (60%) but post-voiding residual urine was sig nificant in 12. Bladder capacity increased from a mean of 77 to 270 ml . Bladder capacity decreased during followup in 3 children, requiring repeat augmentation. Six children had isolated dysuria and 2 had dysur ia with hematuria. Perforation of the gastric patch and a bleeding gas tric ulcer occurred in 1 patient each. Conclusions: The disadvantages of gastrocystoplasty outnumber its advantages after failed bladder exs trophy closure. Urethral sensation makes dysuria a major discomfort. S afety is not optimal, since perforation may occur. Voiding is not effi cient because gastrocystoplasty provides continence only when it is as sociated with intermittent catheterization. Bladder capacity is insuff iciently augmented and inconsistent during followup. We believe that t he use of gastrocystoplasty in cases of failed bladder exstrophy closu re should be reconsidered.