Cystoplasty in Bladder Exstrophy

Indications and Techniques
  • Steven G. Docimo


Despite our institutional preference for functional reconstruction of the child with bladder exstrophy,1 the need for bladder augmentation or continent urinary diversion is not infrequent. Techniques for augmentation have not changed tremendously in the past twenty years, although there are some variations and perhaps some completely new techniques on the horizon.2 The decision to augment the bladder in a patient with exstrophy may allow for urinary continence, but it will also cause significant changes in the patient’s lifestyle. These changes are due to techniques of emptying the augmented bladder, potential complications of the augmented bladder, cosmetic implications of augmentation surgery and potential long-term metabolic and neoplastic consequences of bladder augmentation. Because these operations are generally performed in young children, these considerations must weigh heavily on reconstructive decision making.


Bladder Neck Bladder Augmentation Bladder Exstrophy Augmentation Cystoplasty Continent Urinary Diversion 
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  1. 1.
    Docimo, S.G., Gearhart, J.P., and Jeffs, R.D.: Bladder Exstrophy, in The Bladder, Edited by J.M. Fitzpatrick and Krane, R.J. Edinburgh: Churchill Livingstone: p. 501, 1995.Google Scholar
  2. 2.
    Docimo, S.G.: Options for bladder augmentation wihtout the use of bowel mucosa. Dial Ped Urol, 18: 4, 1995.Google Scholar
  3. 3.
    Caione, P. Lais, A., de, G.M., and Capozza, N.: Glutaraldehyde cross-linked bovine collagen in exstrophy/epispadias complex. J Urol, 150: 631, 1993.Google Scholar
  4. 4.
    Gearhart, J.P. and Jeffs, R.D.: Bladder exstrophy: increase in capacity following epispadias repair. J Urol, 142: 525, 1989.PubMedGoogle Scholar
  5. 5.
    Gearhart, J.P., Canning, D.A., and Jeffs, R.D.: Failed bladder neck reconstruction: options for management. J Urol, 146 (4): 1082, 1991.PubMedGoogle Scholar
  6. 6.
    Mitrofanoff, P.: Neurogenic bladder in children. Current status of our knowledge and treatment by transappendiceal continent cystostomy. [French]. Bull Soc Sci Med Grand Duche Luxemb, (219), 1987.Google Scholar
  7. 7.
    Gearhart, J.P., Peppas, D.S., and Jeffs, R.D.: The application of continent urinary stomas to bladder augmentation or replacement in the failed exstrophy reconstruction. Br J Urol, 75 (1): 87, 1995.PubMedCrossRefGoogle Scholar
  8. 8.
    Arap, S., Martins, G.A., Menezes, de, Goes, and G: Initial results of the complete reconstruction of bladder exstrophy. Urol Clin North Am, 7 (2): 477, 1980.PubMedGoogle Scholar
  9. 9.
    Bauer, S.B., Hendren, W.H., Kozakewich, H., Maloney, S., Colodny, A.H., Mandell, J., and Retik, A.B.: Perforation of the augmented bladder. J Urol, 148: 699, 1992.PubMedGoogle Scholar
  10. 10.
    Gearhart, J.P. and Jeffs, R.D.: Augmentation cystoplasty in the failed exstrophy reconstruction. J Urol, 139 (4): 790, 1988.PubMedGoogle Scholar
  11. 11.
    Cartwright, P.C. and Snow, B.W.: Bladder autoaugmentation: early clinical experience. J Urol, 142: 505, 1989.PubMedGoogle Scholar
  12. 12.
    Dewan, P.A. and Byard, R.W.: Autoaugmentation gastrocystoplasty in a sheep model. Br J Urol, 72 (1): 56, 1993.PubMedCrossRefGoogle Scholar
  13. 13.
    Dewan, P.A. and Stefanek, W.: Autoaugmentation gastrocystoplasty: early clinical results. Br J Urol, 74 (4): 460, 1994.PubMedCrossRefGoogle Scholar
  14. 14.
    Nguyen, D.H., Mitchell, M.E., Horowitz, M., Bagli, D.J., and Carr, M.C.: Demucosalized augmentation gastrocystoplasty with bladder autoaugmentation in pediatric patients. J Urol, 156 (1): 206, 1996.PubMedCrossRefGoogle Scholar
  15. 15.
    Gonzalez, R., Buson, H., Reid, C., and Reinberg, Y.: Seromuscular colocystoplasty lined with urothelium: experience with 16 patients. Urology, 45 (1): 124, 1995.Google Scholar
  16. 16.
    Bellinger, M.F.: Ureterocystoplasty: a unique method for vesical augmentation in children. J Urol, 149 (4): 811, 1993.PubMedGoogle Scholar
  17. 17.
    Dewan, P.A., Nicholls, E.A., and Goh, D.W.: Ureterocystoplasty: an extraperitoneal, urothelial bladder augmentation technique. Eur Urol, 26 (1): 85, 1994.PubMedGoogle Scholar
  18. 18.
    Mitchell, M. and Burns, M.W.: Urinary undiversion and augmentation cystoplasty., in Clinical Pediatric Urology, Edited by P.P. Kelalis, King, L.R., andBelman, A.B. Philadelphia: W.B. Saunders Company: p. 904, 1992.Google Scholar
  19. 19.
    Blyth, B., Ewalt, D.H., Duckett, J.W., and Snyder, H.d.: Lithogenic properties of enterocystoplasty. J Urol, 148: 575, 1992.PubMedGoogle Scholar
  20. 20.
    Palmer, L.S., Franco, 1., Kogan, S.J., Reda, E., Gill, B., and Levitt, S.B.: Urolithiasis in children following augmentation cystoplasty. J Urol, 150: 726, 1993.Google Scholar
  21. 21.
    Mundy, A.R. and Nurse, D.E.: Calcium balance, growth and skeletal mineralisation in patients with cystoplasties. Br J Urol, 69 (3): 257, 1992.PubMedCrossRefGoogle Scholar
  22. 22.
    Sheiner, J.R. and Kaplan, G.W.: Spontaneous bladder rupture following enterocystoplasty. J Urol, 140: 1157, 1988.PubMedGoogle Scholar
  23. 23.
    Rushton, H.G., Woodard, J.R., Parrott, T.S., Jeffs, R.D., and Gearhart, J.P.: Delayed bladder rupture after augmentation enterocystoplasty. J Urol, 140 (2): 344, 1988.PubMedGoogle Scholar
  24. 24.
    Elder, J.S., Snyder, H.M., Hulbert, W.C., and Duckett, J.W.: Perforation of the augmented bladder in patients undergoing clean intermittent catheterization. J Urol, 140: 1159, 1988.PubMedGoogle Scholar
  25. 25.
    Davidsson, T., Lindergard, B., and Mansson, W.: Long-term metabolic and nutritional effects of urinary diversion. Urology, 46 (6): 804, 1995.PubMedCrossRefGoogle Scholar
  26. 26.
    Steiner, M.S., Morton, R.A., and Marshall, F.F.: Vitamin B12 deficiency in patients with ileocolic neobladders. J Urol, 149 (2): 255, 1993.PubMedGoogle Scholar
  27. 27.
    Canning, D.A., Perman, J.A., Jeffs, R.D., and Gearhart, J.P.: Nutritional consequences of bowel segments in the lower urinary tract. J Urol, 142: 509, 1989.PubMedGoogle Scholar
  28. 28.
    Adams, M.C., Mitchell, M.E., and Rink, R.C.: Gastrocystoplasty: an alternative solution to the problem of urological reconstruction in the severely compromised patient. J Urol, 140: 1152, 1988.PubMedGoogle Scholar
  29. 29.
    Nguyen, D.H., Bain, M.A., Salmonson, K.L., Ganesan, G.S., Burns, M.W., and Mitchell, M.E.: The syndrome of dysuria and hematuria in pediatric urinary reconstruction with stomach. J Urol, 150: 707, 1993.PubMedGoogle Scholar
  30. 30.
    Gosalbez, R.J., Woodard, J.R., Broecker, B.H., and Warshaw, B.: Metabolic complications of the use of stomach for urinary reconstruction. J Urol, 150: 710, 1993.PubMedGoogle Scholar
  31. 31.
    Gregoire, M., Kantoff, P., and DeWolf, W.C.: Synchronous adenocarcinoma and transitional cell carcinoma of the bladder associated with augmentation: case report and review of the literature. [Review]. J Urol, 149 (1): 115, 1993.PubMedGoogle Scholar
  32. 32.
    Elder, J.S.: Continent appendicocolostomy: a variation of the Mitrofanoff principle in pediatric urinary tract reconstruction. J Urol, 148 (1): 117, 1992.PubMedGoogle Scholar
  33. 33.
    Gosalbez, R., Padron, O.F., Singla, A.K., Woodard, J.R., and Galloway, N.T.: The gastric augment single pedicle tube catheterizable stoma: a useful adjunct to reconstruction of the urinary tract. J Urol, 152: 2005, 1994.Google Scholar
  34. 34.
    Sumfest, J.M. and Mitchell, M.E.: Reconstruction of the umbilicus in exstrophy. J Urol, 151 (2): 453, 1994.PubMedGoogle Scholar
  35. 35.
    Ben-Chaim, J., Rodriguez, R., and Docimo, S.G.: Concealed umbilical stoma: description of a modified technique. Journal of Urology, 154 (3): 1169, 1995.PubMedCrossRefGoogle Scholar
  36. 36.
    Docimo, S.G., Moore, R.G., Adams, J., and Kavoussi, L.R.: Laparoscopie bladder augmentation using stomach. Urology, 46 (4): 565, 1995.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Steven G. Docimo
    • 1
  1. 1.The James Buchanan Brady Urological InstituteThe Johns Hopkins HospitalBaltimoreUSA

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