Lower-urinary-tract reconstruction using stomach tissue in children and young adults

Abstract

Between January 1985 and July 1991, a total of 86 patients (50 males, 36 females) underwent reconstruction of the lower urinary tract using gastric tissue. Their mean age was 14 years (range, 1.3–53 years). Augmentation gastrocystoplasty was performed in 79 cases and total gastric-bladder substitution in 7 others. The diagnoses were cloacal exstrophy (13 patients), classic bladder exstrophy (23 subjects), myelomeningocele (21 cases), posterior urethral valves (8 patients) nonneurogenic neurogenic bladder (7 subjects), and others (14 cases). The mean follow-up period was 26.5 months (range, 3–65 months). Total daytime and nighttime continence was achieved in 75 patients (87%). Early complications included gastric hemorrhage (2 patients), urinary extravasation (1 subject), subphrenic abscess (1 case), and intraoperative anaphylactic reaction to latex (3 patients). Late complications included dysuria/hematuria syndrome (17 patients, 19.7%), bowel obstruction (7 subjects), augmented bladder perforation (2 cases), gastric atony (1 patient), transient ureterovesical junction obstruction (3 patients), and ureteral reflux (2 subjects). Secondary augmentation ileocystoplasty was required in 2 cases for persistently poor compliance, and 1 patient underwent deaugmentation for intractable metabolic alkalosis. Hypochloremic metabolic alkalosis requiring hospitalization occurred in 9 subjects. Stomach tissue is readily available and represents a viable alternative to bowel tissue for reconstruction of the lower urinary tract. Complications associated with gastrocystoplasty seem to be related to the secretory function of the stomach, whereas complications of intestinocystoplasty are related to the absorptive characteristics of the bowel.