Augmentation cystoplasty

Outcome of augmentation cystoplasty in pediatrics age group with neurogenic bladder:

Outcome of augmentation cystoplasty in pediatrics age group with neurogenic bladder Ata Ur Rahman, Anayat Ullah, Sarhad Khan, Muhammad Kamran Khan, Muhammad Ishfaq. Institute of kidney diseases, Peshawar

There is an old Aristotal saying that , the quality of life is more important than life itself.:

There is an old Aristotal saying that , the quality of life is more important than life itself.

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HOPELESS

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DEPRESSED

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WHO IS ALWAYS MAKE FUN OFF

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CAN NOT BE PREFERRED OVER A CONFIDENT

SOCIALLY CONTINENT:

SOCIALLY CONTINENT

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JOYFULL

Background :

Background

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Decreased bladder capacity or abnormal compliance may manifest as debilitating urgency, frequency, incontinence, recurrent UTIs, pyelonephritis, or progressive renal insufficiency. Background

Freiherr von Mikulicz-Radecki First described the augmentation cystoplasty in humans in 1890:

Freiherr von Mikulicz-Radecki First described the augmentation cystoplasty in humans in 1890

Background:

Today Augmentation cystoplasty is performed for both neuropathic and non-neuropathic causes for severe bladder dysfunction in pediatric and adult populations. Background

Jack Lapides, MD 1914 – 1995 Described clean intermittent self catheterization in 1970 was pivotal in widespread use of augmentation cystoplasty.:

Jack Lapides, MD 1914 – 1995 Described clean intermittent self catheterization in 1970 was pivotal in widespread use of augmentation cystoplasty.

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The introduction of clean intermittent self catheterization has allowed a convenient way of Emptying the safe functional reservoir

Pre-Operative Evaluation:

Urine analysis, urine culture, and cytology Serum Chemistry to rule out metabolic acidosis and to allow for assessment of renal failure Complete Blood Cell Count to identify anemia or infection. Pre-Operative Evaluation

Pre-Operative Evaluation:

Renal Ultrasonography: To assess any upper tract anomalies and renal parenchyma. Voiding cystourethrography to evaluate the bladder size and contour, and the presence of vesicoureteral reflux. Pre-Operative Evaluation

Pre-Operative Evaluation:

Assess urinary continence with a voiding diary and Valsalva leak point pressure Urodynamics was performed in all patients with augmentation cystoplasty. Urolflometry Cystometry Pre-Operative Evaluation

Treatment Protocol:

All patients having high pressure, low volume bladder were evaluated with above mentioned investigations. Patients who were having poor emptying of the bladder were considered for mitrofanoff procedure. Patients with gross HDN and HDU were also considered for ureteroneocystostomy Counseling of the parents were done. Treatment Protocol

Treatment Protocol:

Cystoscopy was performed prior to augmentation cystoplasty, to identify occult urethral valves, strictures, or unsuspected bladder pathology. Treatment Protocol

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Treatment of neurogenic bladder: Surgery

Catheterizable channel:

Catheterizable channel Appendicovesicostomy Mitrofanoff

Objective :

Objective

Objectives:

To evaluate the outcome of augmentation cystoplasty in pediatric age group with neurogenic bladder. Objectives

Patients and Method :

Study design Retrospective study Duration January 2001 to January 2010. Settings Institute of kidney diseases, Peshawar and HMC Peshawar. Sample Size 21 patients Sample Technique Convenient Sampling Inclusion Criteria Children with Neurogenic Bladder Data Collection Structured Performa Data Analysis SPSS V 10 Patients and Method

Results :

Results

AGE AND GENDER:

AGE AND GENDER

+/- Mitrofanof Procedure:

+/- Mitrofanof Procedure Without MF=6 With MF= 15

Bilateral Ureteroneocystostomy:

Bilateral Ureteroneocystostomy With Bilateral Ureteroneocystostomy 12 patients

Follow Up RFTs Bladder Compliance:

Follow Up RFTs Bladder Compliance Mean Bladder Compliance=13.7 ml/cm of H2O Range 11.9 to 14.2) Mean Bladder volume 320 ml Range 280 to 420 ml)

n=21:

n=21

Complications :

Complications

Comparison with other studies :

University of Tübingen , Department of Pediatric Surgery, Tübingen , Germany. Results : Postoperative urodynamics revealed a significant increase in bladder volume (median 400 ml) as well as a significant improvement in bladder compliance (median 13.5 ml/ cmH (2)O). 90% of the patients were reported to be socially continent. Renal function remained stable in 95% and decreased in 5% of the children . Major complications were lower urinary tract calculi (39%), stricture or insufficiency of the continent vesicostomy (28%), and intestinal obstruction (9%) Obermayr F , Szavay P , Schaefer J , Fuchs .J Pediatr Surg. 2010 Nov 4. Outcome of Augmentation Cystoplasty and Bladder Substitution in a Pediatric Age Group. Comparison with other studies

Conclusion:

Augmentation cystoplasty preserve renal functions and provide urinary continence in most children with neurogenic bladder . Conclusion