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Neurogenic Bladder Dysfunction: Outcome Following Gastrocystoplasty - Abstract

Hemonta Kr Dutta, Diganta Saikia


Abstract

Aims: Augmentation cystoplasty is the ideal therapy for children with neurogenic bladder dysfunction, who failed to respond to conservative treatment. Gastric patch is preferred over ileal, cecal or colonic patches as post-operative metabolic complications are less following gastrocystoplasty.

Patients and methods: Four children (1 male and 3 females; median age 45 months) presented with severe urgency, frequency and incontinence. Two patients had lumbosacral lipo-meningomyelocele, one had spina bifida with tethered cord and the 4th patient had caudal regression syndrome. All of them had moderate hydro-ureteronephrosis and thickened small capacity bladder with average bladder capacity of 50 ml. All the four patients were operated for correction of primary neurological problem followed by augmentation cystoplasty, ureteric reimplantation and Mitrofanoff’s procedure. Bladder neck repair or strengthening was needed in 3 patients.

Results: Two patients had early complications: one had prolonged urinary leak from suprapubic drain site, which eventually closed and the 2nd patient had temporary incontinence but achieved full continence in 6 months time. Bladder sensation returned to 3 patients and all 4 patients could achieve total continence and could hold urine from 1 to 2½ hours. All 4 patients could void using abdominal pressure and intermittent catheterization. Upper tract function was stable and bladder capacity was adequate in all of them and average post-void residue was less than 10 ml. Median follow up period was 50.6 months.

Conclusion: Gastrocystoplasty is an excellent method of treatment for children with neurogenic bladder dysfunction with renal insufficiency. Bladder neck strengthening may be necessary to achieve continence.

Keywords: neurogenic bladder, augmentation cystoplasty, gastrocystoplasty, complications.

 

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