Augmentation Cystoplasty

Abstract

Bladder augmentation (BA) with GI tissue is an important tool in the armamentarium of the urologist in the management of children requiring reconstruction for urinary incontinence, preserving the upper urinary tract, and reconstructions for severe congenital malformations. The main goal of bladder augmentation is a creation of a low-pressure urinary reservoir in order to maintain renal function and to avoid urinary incontinence. After introduction of clean intermitted catheterization to the clinical practice, augmentation cystoplasty (AC) with various intestinal segments grew rapidly and changed the management of pediatric and adult patients with abnormal bladder function. The current techniques for pediatric BA are cystoplasty with stomach, large bowel, small bowel, ileocecal, ureter, and engineered tissue with or without urinary continence procedures. Gastrointestinal tissue used for enterocystoplasty is associated with various short- and long-term complications, and the search for the ideal tissue is still ongoing (Adams et al. 1988; Hitchcock et al. 1994; Perovic et al. 2000). Reservoir perforation must be considered in patients with acute abdominal pain or peritonitis, and long-term follow-up of renal function is needed. The practicing urologists and pediatric surgeons have to be aware of the longterm risk of malignancy in these procedures. Therefore, there is a current necessity to develop alternative tissues for bladder augmentation by the help of tissue engineering protocols that will replace the integration of bowel segments into the urinary tract. Until then, intestinal cystoplasty still seems to be the gold standard due to the lack of promising alternative options.