921 LONG-TERM OUTCOMES OF THE USE OF GASTRIC SEGMENTS FOR LOWER URINARY TRACT RECONSTRUCTION

Abstract

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 2010921 LONG-TERM OUTCOMES OF THE USE OF GASTRIC SEGMENTS FOR LOWER URINARY TRACT RECONSTRUCTION Miguel Castellan, Rafael Gosalbez, Yuval Bar-Yosef, and Andrew Labbie Miguel CastellanMiguel Castellan More articles by this author , Rafael GosalbezRafael Gosalbez More articles by this author , Yuval Bar-YosefYuval Bar-Yosef More articles by this author , and Andrew LabbieAndrew Labbie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of stomach to augment the bladder is not common. It has been used as an alternative to enterocystoplasty because of its potential advantages, including decreased risk of mucus production, stone formation and urinary tract infections. Over the past 10 years, reported complications prompted a reduction in its use in many centers. METHODS We retrospectively reviewed the charts of 29 patients, 15 girls and 14 boys, who had undergone reconstruction of the lower urinary tract using gastric segments between 1993 and 2000. Median patient age at time of reconstruction was 6.6 years (2-36 years). Diagnoses of patients included neurogenic bladder (21), cloacal exstrophy (5), solitary kidney/ectopic ureter (1), posterior urethral valves (1), rhabdomyosarcoma of prostate (1). Gastric segment was used as gastrocystoplasty (21), composite gastric/enteric (6), demucosalized gastrocystoplasty (1), continent gastric reservoir (1). RESULTS Mean follow-up was 13.9 years (16.5-9 years). Complications were seen in 15 (51.7%) patients. Seven patients had hematuria-dysuria syndrome, in 1 patient was considered severe necessitating excision of the gastric patch. Three patients underwent re-augmentation with enteric segments without excision of the gastric tissue (composite) due to decrease capacity and compliance of the reservoir. One patient who underwent a demucosalized gastrocystoplasty underwent excision of the gastric tissue and reaugmentation with enteric segment due to contraction of the gastric patch. One patient who underwent a composite developed a reservoir stone. Three patients developed malignancy in the reservoir 11, 12 and 14 years after the gastrocystoplasty. CONCLUSIONS We do not recommend the use of gastric segments for reconstruction of the lower urinary tract due to the high incidence of reoperations and complications. In certain specific cases in which gastric segments were the only available option for reconstruction, regular surveillance and close follow-up is advocated. Miami, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e359 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miguel Castellan More articles by this author Rafael Gosalbez More articles by this author Yuval Bar-Yosef More articles by this author Andrew Labbie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...