GASTROCYSTOPLASTY IN ADULTS AND POSTOPERATIVE ACIDURIA

We performed augmentation gastrocystoplasty in five adult female patients with radiation cystitis after excising the injured bladder wall. The gastric segment was isolated from the body of the stomach with the right gastroepiploic vessels. The ureters were reimplanted into the gastric segment in 3 patients. Postoperatively, all patients were able to urinate from the urethra, although 1 patient needed reoperation for postoperative fistula. Since strongly acid urine developed after meal in all patients, they were placed on oral famotidine 40 mg/day. With this medication the urine pH was kept above 5. Follow-up ranged from 6 months to 3 years 2 months. In 3 patients the dosage of famotidine was gradually reduced without any symptoms. In the other 2 patients strongly acid urine caused symptoms despite the medication of famotidine. Of the 2 patients, one developed a small ulcer at the native bladder with occasional urethral pains and hematuria 7 months postoperatively. The ulcer and symptoms were improved by administration of omeprazole for 6 weeks. The other patient who consistently had mild stress incontinence complained of mild urethral and suprapubic pain. These results indicate that gastrocystoplasty is useful for radiation cystitis and postoperative complication secondary to strongly acid urine are controllable by administration of an acid secretion inhibitor.