Sigmoid cystoplasty with argon beam without mucosa

Purpose: Intestinal bladder augmentations have well recognized complication s, including mucus production, metabolic abnormalities and perforation. The se complications may be avoided if the intestinal mucosa is not incorporate d in the urinary tract. We report our experience with sigmoid cystoplasty w ithout mucosa using argon beam, and describe the clinical, urodynamic, ultr asound and pathological results. Materials and Methods: We performed sigmoid cystoplasty without mucosa in 2 6 patients and with argon beam over the mucosa before it was removed in 6 b oys and 4 girls with a mean age of 8 years (range 3 to 14). All patients ha d neurogenic bladder as the initial disease. Indications for augmentation w ere poor bladder compliance, low bladder capacity, hydronephrosis and urina ry incontinence. Mean followup was 18 months (range 8 to 40) and included u ltrasound, urodynamic evaluation, renal function and clinical assessment. I n all patients intraoperative biopsies were done. In 8 of the 10 patients e ndoscopic biopsies of the augmented segment were obtained between 6 months and 2 years postoperatively. The operation consisted of the Goodwin techniq ue without mucosa, which was treated with argon beam before it was removed. Results: The 10 patients are dry on intermittent clean catheterization with intervals of greater than 4 hours. There have been no clinical urinary tra ct infections. Two patients presented with peristaltic contractions and no symptoms. Bladder capacity increased from 80 (range 45 to 200) to 300 (220 to 400) mi., and mean postoperative compliance was 15 ml./cm. H2O (range 9 to 38). There were no significant changes in the urodynamic data between pa tients treated with sigmoid cystoplasty without mucosa only and with argon beam. Intraoperative biopsies after treatment with argon beam showed damage d mucosa and muscularis mucosa, and intact serosa, muscularis and submucosa layers. On the 8 argon beam postoperative biopsies the sigmoid submucosa w as covered with a pseudostratified metaplasia of connective tissue with col lagen fibers without scars (trichromic technique). Conclusions: Sigmoid cystoplasty without mucosa with argon beam is easy to perform. The clinical and urodynamic results have been satisfactory, and us e of argon beam prevents postoperative bleeding and residual glands.