Bladder augmentation means the creation of a urinary reservoir made up of the original bladder, or part of it, and a part of the gastrointestinal tract (stomach, ileum, caecum, sigmoid colon) isolated and anastomized to the bladder [14]. The urethra is conserved and the ureters are usually re-implanted into the bladder. At first this type of surgery was used exclusively for adult patients affected by vesical tuberculosis, vesical carcinoma, interstitial cystitis or in patients with neurogenic bladder; however, this technique has recently been used for the reconstruction of the urinary tract in younger patients affected by complex urogenital malformations or by neurogenical bladder [5, 6]. Until about 2025 years ago many of these conditions were treated with an external urinary derivation or, in some selected cases, an internal one. The past few years have, however, seen the preference of reconstructive surgery of the inferior urinary tract by means of vesical augmentation or substitution (rare in paediatnc age), containing urinary derivations, reconstructions of the vesical neck and proximal ureter. It is important to emphasise that these methods are possible thanks to the proved efficacy of clean intermittent catheterization (GIG) introduced by Lapides in the 1970s [7]. This procedure allows the passive drainage of a constructed reservoir and, in the cases in which spontaneous urination is foreseen, has an important re-educative role. It is also important to stress the selection of the patients in as much as this type of surgery is an alternative to external derivation, and avoids the use of external urine collection sacs but forces a passive drainage of the new reservoir (GIG); therefore, it is necessary to evaluate the physical limitations as well as the family and social! psychological limitations of the patients who are candidates for this type of surgery, and to indicate, other than the advantages, the risks linked to a containing urinary reservoir that is not correctly managed. In paediatric age and adolescence the indication for vesical augmentation is proposed when there is a small, inelastic, incontinent bladder with high internal pressure, conditions that can cause a worsening of the upper urinary tract due to stasis or secondary reflux [8]. The conditions of this type are: 1. Neurogenic bladder (spina bifida) 2. Major malformations: estrophyepispadia complex, posterior urethra valve, estrophy of the cloaca 3. Vesical fibrosis secondary to radiotherapy 4. Single bilateral urethral ectopia 5. High degree vesico-ureteral reflux with small inelastic bladder secondary to chronic phlogosis (rare). © 2006 Springer-Verlag Berlin Heidelberg.
Gastrocystoplasty
Di Benedetto V.;Arena C.;Scuderi M. G.;Di Benedetto A.
2006-01-01
Abstract
Bladder augmentation means the creation of a urinary reservoir made up of the original bladder, or part of it, and a part of the gastrointestinal tract (stomach, ileum, caecum, sigmoid colon) isolated and anastomized to the bladder [14]. The urethra is conserved and the ureters are usually re-implanted into the bladder. At first this type of surgery was used exclusively for adult patients affected by vesical tuberculosis, vesical carcinoma, interstitial cystitis or in patients with neurogenic bladder; however, this technique has recently been used for the reconstruction of the urinary tract in younger patients affected by complex urogenital malformations or by neurogenical bladder [5, 6]. Until about 2025 years ago many of these conditions were treated with an external urinary derivation or, in some selected cases, an internal one. The past few years have, however, seen the preference of reconstructive surgery of the inferior urinary tract by means of vesical augmentation or substitution (rare in paediatnc age), containing urinary derivations, reconstructions of the vesical neck and proximal ureter. It is important to emphasise that these methods are possible thanks to the proved efficacy of clean intermittent catheterization (GIG) introduced by Lapides in the 1970s [7]. This procedure allows the passive drainage of a constructed reservoir and, in the cases in which spontaneous urination is foreseen, has an important re-educative role. It is also important to stress the selection of the patients in as much as this type of surgery is an alternative to external derivation, and avoids the use of external urine collection sacs but forces a passive drainage of the new reservoir (GIG); therefore, it is necessary to evaluate the physical limitations as well as the family and social! psychological limitations of the patients who are candidates for this type of surgery, and to indicate, other than the advantages, the risks linked to a containing urinary reservoir that is not correctly managed. In paediatric age and adolescence the indication for vesical augmentation is proposed when there is a small, inelastic, incontinent bladder with high internal pressure, conditions that can cause a worsening of the upper urinary tract due to stasis or secondary reflux [8]. The conditions of this type are: 1. Neurogenic bladder (spina bifida) 2. Major malformations: estrophyepispadia complex, posterior urethra valve, estrophy of the cloaca 3. Vesical fibrosis secondary to radiotherapy 4. Single bilateral urethral ectopia 5. High degree vesico-ureteral reflux with small inelastic bladder secondary to chronic phlogosis (rare). © 2006 Springer-Verlag Berlin Heidelberg.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
