GASTROCYSTOPLASTY - LONG-TERM FOLLOW-UP

Purpose: Gastrocystoplasty is no longer favored at many institutions d ue to complications, including the hematuria-dysuria syndrome and meta bolic alkalosis. We reviewed our experience to determine the advantage s and disadvantages of bladder augmentation using stomach body wall. M aterials and Methods: We retrospectively reviewed the medical records, urodynamic studies, x-rays and laboratory evaluations of 47 children who underwent gastrocystoplasty at our institution between 1986 and Ju ne 1997. Parents and patients were contacted by telephone for detailed interviews to validate the medical record and determine whether there had been any changes since the last visit. Followup ranged from 9 mon ths to 11 years (mean 4.4 years). Bladder dysfunction was secondary to spinal dysraphism in 38 children. Other diagnoses included cloacal an d bladder exstrophy, posterior urethral valves, a persistent urogenita l sinus and bilateral ectopic ureters. Results: Preoperative and posto perative ultrasound studies available for 79 renal units demonstrated a stable or improved upper tract in 75 (95%). Preoperative and postope rative serum sodium, potassium and creatinine levels showed no signifi cant changes. Mean serum chloride decreased 2.7 mEq./1. and bicarbonat e increased 3.3 mEq./1. In the 3 patients with renal insufficiency ser um bicarbonate increased 8 mEq./1. Mean pressure specific bladder volu me at less than 20 cm, water increased 177 cc and mean maximum bladder pressure decreased fi-om 35 to 13 cm. water. Two-thirds of the patien ts had bacilluria and a fourth reported a symptomatic bladder infectio n. No patients had bothersome mucus or required routine bladder irriga tion. Symptoms consistent with the hematuria-dysuria syndrome were pre sent in 27% of the patients. No patients had symptoms more than once w eekly. Symptoms occurred in 75% of the patients without a neurogenic b ladder, such as exstrophy or posterior urethral valves, and in 14% of those with neurogenic bladder dysfunction. In 1 case a bladder stone d eveloped 8 years after surgery. Five patients required reoperation for complications related to gastrocystoplasty. No patient had perforatio n. Conclusions: Our data show that even after a mean of 4.4 years gast rocystoplasty has significant advantages over intestinal augmentation, including decreased chloride reabsorption, mucous production and urin ary infection, and an extremely low incidence of stones and perforatio n. The gastric patch is associated with metabolic alkalosis and the he maturia-dysuria syndrome, which may be avoided and medically treated w ith proper patient selection and close followup. The procedure should be avoided in sensate patients with sufficient bowel.