Clinical and urodynamic evaluation after ureterocystoplasty with differentamounts of tissue

Purpose: Ureter is one of the best tissues for bladder augmentation. The am ount of ureteral segment available is extremely variable among patients. We compared results in patients who underwent ureterocystoplasty with 2 urete rs, 1 complete ureter or a distal segment only after transureteroureterosto my. Materials and Methods: During a 6-year period we performed 32 ureterocystop lasties at 2 pediatric centers in Argentina (16) and Chile (16). Median pat ient age at surgery was 9 years (range 4 months to 20 years). Clinical pres entation included urinary infection, hydronephrosis, incontinence and undiv ersion. The diagnosis was neurogenic bladder in 20 cases, infravesical obst ruction in 7, massive reflux in 3 and ureterocele in 2. All patients had po or bladder compliance and vesicoureteral reflux. We used different options to augment the bladder, including 2 ureters in 5 patients, bilateral nephre ctomy in 3, a complete duplex system in 1 and a bilateral partial ureter in 1 (group I); a complete ureter in 14 (group 2), and a distal segment of ur eter with transureteroureterostomy in 13 (group 3). When transureteroureter ostomy was performed, a suprapubic tube remained indwelling for 2 weeks and a Double-J* stent was placed for 1 month. Median followup was 16 months (r ange 4 months to 6 years). Clinical and radiological evaluations, including ultrasound, cystography, urodynamics, renal scan and renal function measur ement, were done 4 months postoperatively and twice yearly thereafter as ne eded. Results: We noted no significant difference in bladder capacity when 1 or 2 ureters were used. Median increase in bladder capacity in groups 1 and 2 w as 375% (range 80 to 800). All patients who received a complete segment of ureter had clinical improvement, decreased hydronephrosis and resolution of reflux with improved bladder compliance. When a partial segment of ureter was used median capacity increased 230% (range 40 to 400) with clinical imp rovement in 12 patients (92.3%). Compliance improved, which led to longer i ntervals between clean intermittent catheterizations. No patient has needed repeat augmentation to date. Conclusions: There is a difference in median increased bladder capacity whe n a segment of distal ureter is used to augment the bladder versus 1 or 2 w hole ureters. However, the use of distal ureter still represents a safe alt ernative for augmenting the bladder and simultaneously resolving massive re flux. Ureterocystoplasty is an excellent choice for increasing bladder capa city and improving bladder compliance despite the different amounts of tiss ue available.