Monday, March 11, 2013

Augmentation Cystoplasty (part 1)


·         Author: Pravin K Rao, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS

   Bladder augmentation, also called augmentation cystoplasty, is a surgical procedure used in adults and children who lack adequate bladder capacity or detrusor compliance.[1, 2, 3] For many patients, augmentation cystoplasty can provide a safe functional reservoir that allows for urinary continence and prevention of upper tract deterioration.
Both neuropathic and non-neuropathic causes for severe bladder dysfunction exist in pediatric and adult populations. Neuropathic causes include the following:
·         Spinal cord injury
·         Multiple sclerosis
·         Myelodysplasia
·         Tethered spinal cord
Nonneuropathic causes include the following:
·         Detrusor instability
·         Chronic cystitis, including tuberculosis and schistosomiasis
·         Interstitial cystitis
·         Radiation cystitis
·         Classic or cloacal exstrophy
·         Defunctionalized bladder in a patient who is on dialysis
Decreased bladder capacity or abnormal compliance may manifest as debilitating urgency, frequency, incontinence, recurrent urinary tract infections (UTIs), pyelonephritis, or progressive renal insufficiency.
Various studies used to evaluate such symptoms may reveal severe dysfunction. Urodynamic studies demonstrate a low-volume, poorly compliant reservoir, which places the kidneys at risk from high-pressure urinary storage. Simultaneous fluoroscopic videourodynamic evaluation may reveal vesicoureteral reflux. Renal ultrasonography or other imaging modalities may show renal scarring or impaired renal growth due to high-pressure urinary storage.

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