Ureterocystoplasty in bilaterally functional kidneys

Objective: Traditional augmentation cystoplasty using gastrointestinal segm ents is known to be associated with metabolic abnormalities and alterations in the bladder causing potential carcinogenesis. In this respect alternati ve techniques have been searched preferably lined by urothelium. We perform ed ureterocystoplasty in 7 patients with a diagnosis of neurogenic bladder and investigated the clinical and functional aspects. Patients and Methods: Between 1995 and 1999, ureterocystoplasty was perform ed using both ureters in 4 male and 3 female children with bilaterally func tional kidneys. Patients' ages varied between 1 and 7 (mean 4.7) years. Bef ore the operation all the children were incontinent, had a small-capacity n oncompliant bladder, and high-grade (IV-V, International Classification Sys tem) reflux on voiding cystouretrography (VCU). Technetium-99m DTPA renal s cintigraphy was also performed in all children to evaluate renal function b efore and after the operation. Results: Before the operation the mean end-filling intravesical pressure wa s 45.6 (35-60) cm H2O which decreased to 18.9 cm H2O 3 months postoperative ly. The mean bladder capacity 3 months after ureterocystoplasty was found t o be 279.3 (250-330) mi. All the children were continent and VCU showed the absence of reflux. There was mild to moderate improvement in renal functio n after surgery in both kidneys on technetium-99m DTPA renal scintigraphy. Three (43%) patients could void spontaneously with abdominal straining, whe reas 4 (57%) children could empty their bladders by clean intermittent cath eterization. A double-cl stent was inserted in 1 (14%) patient because of a rise in serum creatinine after the removal of the ureteral catheter. Patie nts were followed for a mean period of 30 (8-50) months and all the childre n remained continent. The bladder capacity and end-filling pressure measure ments were also stable. Conclusion: Ureterocystoplasty was found to be an effective method for blad der augmentation in bilaterally functional kidneys with an acceptable compl ication rate Copyright (C) 2000 S. Karger AG. Basel.