A therapeutic method for failed bladder augmentation in children

This study by Vajda et al investigated the potential causes leading to the deterioration of a previously successful bladder augmentation. 

They also evaluated the overall experience with re-augmentation. Between 1988 and 2004, 136 bladder augmentations were performed in this study out of Turkey and Hungary. Re-augmentation was necessary in 2 patients after colocystoplasty and in 3 after gastrocystoplasty. A secondary augmentation was not required in any patients after ileocystoplasty.

On the basis of the clinical signs and urodynamic studies, re-augmentation was performed quite some time after the initial augmentation cystoplasties ranging 2–7 years. A trial of anticholinergic therapy was given before re-augmentation, but it did not improve bladder capacity, intravesical pressure, or bladder compliance. An ileal or sigmoid segment was used for the secondary augmentation. After re-augmentation, all five patients became continent and showed marked improvement in their urodynamic parameters at a mean follow-up of 6.8 years (range 2–10 years).

The group postulated that a decreased bladder capacity and/or compliance and increased bladder pressure after successful augmentation cystoplasty might be the result of two things.  The first might be an impairment of the blood supply to the large bowel or gastric segment used for augmentation.  The second may be bowel augment segment contractions.  They state in this paper that ileocystoplasty seems to be the best “first-line” of choice for primary augmentation. They conclude that re-augmentation with a bowel segment is a suitable treatment if conservative treatment fails, i.e. anticholinergic therapy. It seems prudent to perform regularly urodynamic studies, possibly on a yearly basis with upper tract ultrasonography to detect malfunction of the augmented bladder.  One can then make a plan of action.  Although the group used sigmoid colon for re-augmentation in some patients, it seems that if the ileum is available, it may be the best segment until a better option becomes available from out tissue engineering colleagues.

By Pasquale Casale, MD

Reference: 

BJU International, 97(4): 816-819, April 2006.

http://www.ncbi.nlm.nih.gov/entrez/

Vajda P, Buyukunal CS, Soylet Y, Danismed N, Juhasz Z, Pinter AB

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