Ureterocystoplasty: An Ideal Method for Vesical Augmentation in Children

 

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Abstract

Background: Inadequate therapy endangers upper urinary tract function in children with low compliance bladders. We report our approach of increasing bladder compliance using the patients own (mega)-ureter for bladder augmentation. Patients: A total of 8 children underwent ureterocystoplasty. The etiology of bladder non-compliance and the need for augmentation was neurogenic in 5 children, posterior urethral valves in 2 children and in one child the situation after ­repeated antireflux surgery. In all patients the kidney of the used ureter was functionless. Surgery was done through a transperitoneal approach. After nephrectomy, the renal pelvis and the ureter were spatulated and sutured into the bladder incision. An additional MACE stoma was made in 3 patients, antireflux surgery for the contralateral kidney was necessary in 2 patients and one patient underwent stone removal in the remaining kidney. In 1 patient the ureter was used as a free transplant and was covered by an omental flap. In addition, a simultaneous living donor kidney transplant was performed (case 2). Results: Bladder capacity and compliance improved significantly in all patients. The function of the ureter which was used as a free transplant showed good clinical results. The longest follow-up is 8 years. Conclusion: Ureterocystoplasty is a useful and metabolically neutral alternative to bowel segments. In patients with only one functioning ­kidney and a contralateral megaureter, ureterocystoplasty is the treatment of choice in our institution.

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Prof. Dr. med. Dr. h. c. S. C. Müller

Klinik u. Poliklinik für Urologie · Universität Bonn

Sigmund-Freud-Str. 25

53105 Bonn

Phone: 02 28 / 2 87-1 41 80 und -1 41 81

Fax: 02 28 / 2 87-1 41 85

Email: Stefan.Mueller@ukb.uni-bonn.de