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Purpose: The use of stomach has become controversial in pediatric lower urinary tract reconstruction. Recent series have reported a high incidence of hematuria-dysuria syndrome and metabolic abnormalities, which has prompted a significant decrease in its use at our institution during the last 5 years., Materials and Methods: We retrospectively reviewed the medical records of children who underwent urinary reconstruction with gastrocystoplasty. Patients were excluded from consideration if they had less than 5 years of followup., Results: From 1989 to 1997, 18 males and 26 females were identified. Median patient age at time of reconstruction was 4.5 years and median followup was 9.8 years. Urinary continence was present in 89% of cases, and upper tract dilatation was stable or improved in 91%. No patient had chronic metabolic alkalosis. Major surgery was required for complications of the gastrocystoplasty in 6 cases, including patch contraction and ureteral obstruction necessitating excision in 1. Two patients had severe hematuria while anuric from renal failure which was managed conservatively with bladder cycling and H2 blockers. Symptoms resolved completely after renal transplantation in both cases. Febrile urinary tract infection occurred in 20% of cases and asymptomatic bacteriuria was present in 36%., Conclusions: The use of stomach segments in pediatric urinary reconstruction can be beneficial in patients with chronic renal insufficiency, metabolic acidosis or short gut syndrome. Despite negative reports concerning serious complications of gastrocystoplasty, our long-term data confirm that it remains an important option in our reconstruction armamentarium.

Objectives: To present our experience with the use of stomach, ileum, and colon for augmentation cystoplasty to examine the incidence of, and risk factors for, spontaneous perforation. Spontaneous bladder perforation is a potentially life-threatening complication of augmentation cystoplasty with a reported incidence of up to 13%., Methods: A retrospective review of medical records from 1988 to 2001 identified 107 children (57 males and 50 females) who underwent augmentation cystoplasty at our institution. The etiology for bladder dysfunction included myelomeningocele, VATER (vertebral defects, imperforate anus, tracheoesophageal fistula, radial and renal dysplasia) syndrome, bladder and cloacal exstrophy, posterior urethral valves, and pelvic malignancy. Thirteen patients also had end-stage renal disease., Results: The median follow-up was 7.4 years. Gastrocystoplasty was performed in 50 children (47%), ileocystoplasty in 37 (35%), colocystoplasty in 18 (17%), and gastric-ileal composite neobladder in 2 (2%). Augmentation cystoplasty procedures were performed using a standard technique that included a two-layer anastomosis. Additional procedures at the time of reconstruction included Mitrofanoff neourethra in 66 patients (62%) and bladder neck repair in 44 (41%). Postoperatively, most patients started a strict incremental catheterization regimen. The overall incidence of bladder perforation was 5%, with one traumatic (1%) and four spontaneous (4%) perforations. All patients recovered uneventfully after exploratory laparotomy., Conclusions: We believe that the relatively low incidence of spontaneous bladder perforation encountered in this series may be explained by the large number of patients with gastrocystoplasty, as well as our strict adherence to a postoperative incremental catheterization program.

Purpose: Extravesical detrusorrhaphy has been successful for correcting unilateral vesicoureteral reflux, although its use in bilateral ureteral reimplantation has been questioned because of a reportedly high incidence of significant postoperative voiding dysfunction. We reviewed the incidence of voiding dysfunction after bilateral extravesical detrusorrhaphy during the last 5 years., Materials and Methods: From 1990 to 1995, 123 patients with a mean age of 5.8 years (231 refluxing renal units) underwent bilateral extravesical detrusorrhaphy. Patients requiring anticholinergic therapy or intermittent catheterization at surgery were excluded from study, although in 6 who were included voiding dysfunction had previously resolved., Results: Grades I and II vesicoureteral reflux persisted in 1 and 3 renal units, respectively, representing a 98.3% success rate. There was no postoperative upper urinary tract obstruction. Postoperatively voiding dysfunction developed in 8 patients (6.5%), including 2 with a history of voiding dysfunction. In 3 cases (2.5%) irritative voiding symptoms controlled with oxybutynin chloride resolved 2, 4 and 24 months postoperatively, respectively. In 5 patients (4%) temporary incomplete bladder emptying and/or urinary retention required outpatient Foley catheter drainage or intermittent catheterization for 2 to 21 days., Conclusions: Bilateral extravesical detrusorrhaphy is a highly successful procedure with a low incidence of significant voiding dysfunction. Should this condition develop, in our experience it is transient and of minimal morbidity. We found an increased rate of postoperative voiding dysfunction in younger patients as well as in those with a history of resolved voiding dysfunction.

Purpose: The development of contralateral vesicoureteral reflux following different types of unilateral antireflux surgery has been reported to be as high as 22%. We review our recent experience with unilateral extravesical detrusorrhaphy in regard to the incidence of postoperative contralateral vesicoureteral reflux., Materials and Methods: Between 1990 and 1995, 72 children underwent unilateral extravesical detrusorrhaphy. Of 73 refluxing renal moieties (1 patient had reflux in both moieties of a completely duplicated kidney) reflux grade was II in 35 (48%), III in 25 (34%), IV in 11 (15%) and V in 2 (3%). Common sheath reimplantation for complete ipsilateral duplication was performed in 16 patients., Results: One patient had grade I postoperative ipsilateral vesicoureteral reflux resulting in a success rate of 98.6%. In 4 patients (5.6%) contralateral vesicoureteral reflux developed, and was grade II in 3 and grade I in 1. In all patients contralateral reflux resolved at 16, 17, 18 and 31 months of followup. No additional surgery was required in any patient. There was no association between the incidence of contralateral vesicoureteral reflux, and patient age, gender, preoperative ipsilateral reflux grade and presence of ipsilateral duplication., Conclusions: Unilateral extravesical detrusorrhaphy is a highly successful procedure with a low incidence of postoperative contralateral vesicoureteral reflux. Should reflux develop, it is of low grade with a significant rate of spontaneous resolution.