STOMACH VERSUS SIGMOID COLON IN CHILDREN UNDERGOING MAJOR RECONSTRUCTION OF THE LOWER URINARY-TRACT

A review of 50 patients who underwent intestinocystoplasty (ICP) or ga strocystoplasty (GCP) replacement at our department during an 8-year p eriod is presented. The most common diagnoses were neurogenic bladder and bladder exstrophy. A total of 48 patients underwent augmentation c ystoplasty and 2 had total bladder replacement. Mean follow-up time wa s 42 months. The clinical and metabolic aspects of the two types of IC P are reported. Hyperchloremic acidosis requiring therapy was not enco untered, although mild degrees were seen after sigmoid augmentation in 36% of patients. A dysuria-hematuria syndrome (DHS) was seen in 50% o f the patients who underwent GCP. Operative mortality rate was nil. Si gnificant surgical complications occurred in 36% of the patients. The overall success rate for ICP and GCP in this series was 79.15%. ICP gi ves effective results when used to increase the compliance of the lowe r urinary tract, but problems related to electrolyte absorption, stone s, and mucus production are often encountered. In GCP electrolyte abso rption is practically eliminated, so that this technique can be used i n patients with renal damage. In addition, patients with a normal blad der plate (bladder exstrophy) can achieve normal voiding with time. Th e authors believe that patients must be made aware of the possibility of DHS and that this syndrome needs further investigation.