Stomach versus sigmoid colon in children undergoing major reconstruction of the lower urinary tract

A review of 50 patients who underwent intestinocystoplasty (ICP) or gastrocystoplasty (GCP) replacement at our department during an 8-year period is presented. The most common diagnoses were neurogenic bladder and bladder exstrophy. A total of 48 patients underwent augmentation cystoplasty and 2 had total bladder replacement. Mean follow-up time was 42 months. The clinical and metabolic aspects of the two types of ICP are reported. Hyperchloremic acidosis requiring therapy was not encountered, although mild degrees were seen after sigmoid augmentation in 36% of patients. A dysuria-hematuria syndrome (DHS) was seen in 50% of the patients who underwent GCP. Operative mortality rate was nil. Significant surgical complications occurred in 36% of the patients. The overall success rate for ICP and GCP in this series was 79.15%. ICP gives effective results when used to increase the compliance of the lower urinary tract, but problems related to electrolyte absorption, stones, and mucus production are often encountered. In GCP electrolyte absorption is practically eliminated, so that this technique can be used in patients with renal damage. In addition, patients with a normal bladder plate (bladder exstrophy) can achieve normal voiding with time. The authors believe that patients must be made aware of the possibility of DHS and that this syndrome needs further investigation.