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Intestinocystoplasty and Total Bladder Replacement in Children and Young Adults: Followup in 129 Cases

1987; Lippincott Williams & Wilkins; Volume: 138; Issue: 3 Linguagem: Inglês

10.1016/s0022-5347(17)43264-2

1527-3792

Michael E. Mitchell, Joel A. Piser,

Pediatric Urology and Nephrology Studies

No AccessJournal of UrologyPediatric Articles1 Sep 1987Intestinocystoplasty and Total Bladder Replacement in Children and Young Adults: Followup in 129 Cases Michael E. Mitchell and Joel A. Piser Michael E. MitchellMichael E. Mitchell and Joel A. PiserJoel A. Piser View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)43264-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail A review of 129 consecutive young patients (average age 13.4 years) who underwent intestinocystoplasty or total bladder replacement during a 6½-year period at our institution is presented. The most common diagnosis was myelodysplasia and the average followup was 44 months. The clinical and urodynamic aspects of 4 types of intestinocystoplasty (ileocecal, tubular sigmoid, sigmoid patch and ileal patch) are presented. All 4 operations resulted in a significant increase in bladder volume, with a decrease in filling pressure and, thus, improved vesical compliance. In combination with clean intermittent catheterization renal function was maintained or improved in 91 per cent and urinary continence was achieved in 82 per cent of the patients. Hyperchloremic acidosis requiring therapy was noted only in patients with pre-existing renal insufficiency, although mild hyperchloremia after cystoplasty was seen with all 4 types of cystoplasty. There were no operative mortalities. Significant surgical complications occurred in 36 per cent of the patients, the most common of which was vesicoureteral reflux in the ileocecal cystoplasty. Mass unit peristaltic contractions occurred in 34 per cent of the tubular-shaped bowel segments compared to only 10 per cent of the patch segments. These peristaltic contractions contributed to the greater postoperative morbidity noted in the tubular large bowel cystoplasties. The over-all success rate for intestinocystoplasty in this series was 84 per cent. Intestinocystoplasty is an effective procedure when used to increase the compliance of the lower urinary tract. In combination with clean intermittent catheterization it can be applied successfully to patients with neurogenic bladder dysfunction. Large and small bowel seem to have similar clinical and urodynamic properties. The type of intestinal segment used for intestinocystoplasty seems to be of less importance than the size and configuration. Large bowel in its native tubular configuration should be avoided. (J. Urol., 138: 579–584, 1987) © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byScales C and Wiener J (2018) Evaluating Outcomes of Enterocystoplasty in Patients With Spina Bifida: A Review of the LiteratureJournal of Urology, VOL. 180, NO. 6, (2323-2329), Online publication date: 1-Dec-2008.Altaweel W, Jednack R, Bilodeau C and Corcos J (2018) Repeated Intradetrusor Botulinum Toxin Type A in Children With Neurogenic Bladder Due to MyelomeningoceleJournal of Urology, VOL. 175, NO. 3, (1102-1105), Online publication date: 1-Mar-2006.Lendvay T, Cowan C, Mitchell M, Joyner B and Grady R (2018) Augmentation Cystoplasty Rates at Children’s Hospitals in the United States: A Pediatric Health Information System Database StudyJournal of Urology, VOL. 176, NO. 4S, (1716-1720), Online publication date: 1-Oct-2006.GILBERT S and HENSLE T (2018) METABOLIC CONSEQUENCES AND LONG-TERM COMPLICATIONS OF ENTEROCYSTOPLASTY IN CHILDREN: A 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Volume 138Issue 3September 1987Page: 579-584 Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Michael E. Mitchell More articles by this author Joel A. Piser More articles by this author Expand All Advertisement PDF downloadLoading ...