Augmentation Cystoplasty and Appendicovesicostomy (Mitrofanoff Principle)

Abstract

There are two types of cystoplasty: augmentation cystoplasty, in which the bladder is enlarged, and substitution cystoplasty, in which the bladder is replaced. Augmentation cystoplasty is now commonly performed at most pediatric urological centres. Bladder augmentation has three major goals: to provide a compliant bladder reservoir, to limit bladder contractility, and to increase bladder capacity. Augmentation cystoplasty should allow the urinary tract to remain intact while preserving renal function and providing urinary continence. Various substrates are utilized to augment the bladder; the most commonly used is a segment of ileum, but stomach and large bowel also have been used. Ileum has been demonstrated to be the least contractile segment and therefore has become the tissue most often used for bladder augmentation. Sufficient augmentation should lead to effective bladder capacity.