Ureterocystoplasty: Videourodynamic Assessment

Abstract

We evaluated bladder function outcome in children who underwent ureterocystoplasty based on preoperative and postoperative videourodynamic studies. Between 1977 and 2003, 8 patients with a median age of 6 years who had severe bladder dysfunction underwent ureterocystoplasty as a single surgical procedure. Augmentation was performed in 1 refluxing ureter in 7 patients and with a nonrefluxing megaureter in 1. All patients were evaluated urodynamically before and after augmentation using videourodynamic studies. Preoperative bladder capacity was estimated subtracting the volume trapped inside the refluxing ureter from the total amount of contrast fluid infused into the bladder. Controls included 8 patients matched in age (median 7.8 years) and diagnosis who had undergone ileocystoplasty and were studied with the same urodynamic methodology. Median age in patients with ureterocystoplasty and controls at postoperative urodynamic testing was 7.3 and 11.2 years, respectively. Median cystometric bladder capacity for age before and after ureterocystoplasty was 75% (range 10% to 92%) and 94% (range 49% to 100%), respectively. In the ileocystoplasty group cystometric bladder capacity increased significantly after augmentation (median 44% vs 118, p <0.0005). Comparison of postoperative cystometric bladder capacity between the 2 treatment groups showed significantly higher bladder volumes in the ileocystoplasty group (median 217 vs 290 ml, p <0.02). When we analyzed compliance before and after ureterocystoplasty, no statistically significant difference was found (4.09 vs 10.5 ml/cm water). The same parameter in the ileocystoplasty group was statistically significant (1.6 vs 22.5 ml/cm water, p <0.016). Our retrospective study suggests that, although ureterocystoplasty is a useful method for improving bladder storage abnormalities in properly selected patients, enterocystoplasty is associated with a better storage function outcome.