The Syndrome of Dysuria and Hematuria in Pediatric Urinary Reconstruction with Stomach

Nguyen, Donald H.; Bain, M.A.; Salmonson, Kathy; Ganesan, George S.; Burns, Mark W.; Mitchell, Michael E.

doi:10.1016/s0022-5347(17)35593-3

Cited by 168 publications

(47 citation statements)

References 9 publications

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“…In the past decade, many authors restricted the indications of open gastrocystoplasty because of the increasing appearance of hematuria-dysuria (6,14), despite the small number of patients presenting this complication in several series and the good response to clinical management with proton pump inhibitors (14,15). Another complication reported, the hypocloremic metabolic alkalosis (5), is a rarely seen entity that can be prevented by proper electrolyte correction in the management of acute diarrhea.…”

Section: Commentsmentioning

confidence: 99%

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Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

et al. 2007

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Objective: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. Material and methods:We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. Results: Mean total operative time was 5.2 (range 3.5 -8) hours: 84.5 (range 62 -110) minutes for the gastric dissection, 56 (range 28 -80) minutes for the gastric suturing, and 170.6 (range 70 to 200) minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. Conclusions: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.

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Section: Commentsmentioning

confidence: 99%

“…The emergence of complications caused by gastric secretion, including hematuria-dysuria syndrome and hypochloremic metabolic alkalosis, as well as necessity for a large abdominal incision to harvest the gastric wedge and anastomose it to the bladder, have restricted the use of gastrocystoplasty (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

et al. 2007

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“…Traditional clam enterocystoplasty, involving the insertion of a full-thickness enteric bowel segment into the opened bladder, introduces bowel mucosa into the urinary tract. Associated problems may include excessive mucus production, stone formation, metabolic changes (acidosis, ammonaemia) and electrolyte disturbances (hyperchloraemia, hypercalciuria), fibrosis and contraction of the flap, and spontaneous bladder rupture and malignancy [1][2][3][4]. Preserving the urothelium with bladder augmentation can be accomplished by various methods, including autoaugmentation, ureterocystoplasty, diverticulocystoplasty and skeletal myofascial inlays, all of which avoid the use of enteric segments [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Autoaugmentation gastrocystoplasty: further studies of the sheep model

Anderson²,

Edwards³

et al. 2004

BJU International

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and experimental animals 6 months after surgery. The animals were then killed and the bladders evaluated for gastric flap survival and histological changes in the native bladder and augmentation segments. The results were analysed using a one-sided Student's t -test. RESULTSThe median (range) native bladder volume at leak-point pressure was 110 (40-490) mL. Intraoperative bladder volumes after completing AAGC confirmed adequate augmentation segments in all animals. The urodynamic evaluation at 6 months after AAGC showed increases in bladder volumes in nine of 10 animals (0-1336 mL), significantly greater than the increase in volume in the control sheep (median 337.5 vs 115.3 mL; P < 0.05). The bladder compliance (volume/ pressure at leak capacity) 6 months after AAGC was slightly better but not significantly higher than in controls (median 17.3 vs 10.8 mL/cmH 2 O; P > 0.05). The median (range) ratio of surviving gastric flap to native bladder circumferences was 34.5 (31-53)%. Histology showed scarring of the submucosal layer in one of 10 augmentation segments and normal urothelium in all bladders. CONCLUSIONAAGC produces reliable bladder augmentation and excellent bladder compliance in a sheep model of a non-neurogenic bladder. The gastric flap survived well and there was no bladder wall separation with simple postoperative catheter drainage.

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“…A gastric segment in the lower urinary tract will not absorb chloride and ammonium, but it will in fact secrete chloride, and urine remains mucus-free [4]. Later the popularity of gastrocystoplasty decreased when its disadvantages, like dysuria, hematuria and small volume, became evident [5,6].…”

Section: Introductionmentioning

confidence: 99%

Ulcer Perforation in Gastric Urinary Conduit: Never Use a Gastric Segment in the Urinary Tract if There Are Other Options Available

Tainio

Kylmälä

Tammela³

2000

Urol Int

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A male patient, who had had a conservatively treated hemorrhagic peptic ulcer 12 years earlier, underwent gastrocystoplasty after radical cystoprostatectomy for carcinoma of the urinary bladder. After operation the patient suffered urinary incontinence and dysuria which he found so bothersome that the gastric bladder was converted to diversion using the same gastric segment as a tube. Postoperatively there were clots of blood in stomal urine and after the kidneys had been drained intestinal fluid oozed from the stoma. On the 14th postoperative day the patient died of pulmonary embolism. The autopsy showed a perforated peptic ulcer in the gastric segment resulting in a closed fistula to the small bowel. Most probably the reason for development of the peptic ulcer was stress caused by the operation and it might have been avoided by using hydrogen-blocking agents. This case seriously questions whether a gastric segment should be used in the urinary tract at all, and at least it should never be used as a conduit.

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The Syndrome of Dysuria and Hematuria in Pediatric Urinary Reconstruction with Stomach

Cited by 168 publications

References 9 publications

Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

Autoaugmentation gastrocystoplasty: further studies of the sheep model

Ulcer Perforation in Gastric Urinary Conduit: Never Use a Gastric Segment in the Urinary Tract if There Are Other Options Available

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