An Experience of Augmentation Gastrocystoplasty in the Treatment of a Child with Spastic Neurogenic Bladder

Chong, Ce Il; Yoon, Ki Kyun; Sung, Gyung Tak; Kwon, Heon Young; Yoon, Jin Han

Abstract

A small capacity, poor compliant neurogenic bladder is a difficult problem in children. Bladder augmentation with intermittent catheterization offers an alternative to indwelling catheterization. Ileum, cecum, and sigmoid colon have been most commonly used for enterocystoplasty but may, however, cause hyperchloremic metabolic acidosis. The use of the stomach to create urinary reservoir has several theoretical and real advantages. Electrolyte reabsorption is diminished which makes the stomach the selected reservoir. Hyperchloremic metabolic acidosis would not be a problem. In fact, in addition to presenting a barrier against the absorption of chloride and ammonium, the gastric mucosa secretes chloride ions. Gastric segment was isolated with right gastroepiploic artery as a pedicle. Bladder was opened vertically and augmented with gastric segment. This case had increased bladder volume and the dilatation of upper urinary tract decreased in size, including loss of VUR. Laboratory examination showed no metabolic derangement in blood gas analysis and electrolytes. We did not encounter any troubles in CIC such as the obstruction caused by mucus produced by gastric segment. Also, in patients in whom shortening of the bowel may be expected to lead to variable degrees of malabsorption, stomach is an attractive alternative. So, gastrocystoplasty is a reliable method of a creating a large and compliant urinary reservoir. We report a case of augmentation gastrocystoplasty in the treatment of spastic neurogenic bladder in a 6-year-old female.