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OBJECTIVE LONG-TERM EVALUATION AFTER BLADDER AUTOAUGMENTATION WITH RECTUS MUSCLE BACKING
Background: Bladder autoaugmentation with rectus muscle backing has been demonstrated to be an efficient surgical technique for bladder augmentation. Our aim was to objectively evaluate the long-term outcomes and to define value of this procedure.
Methods: Between August 1999 and June 2004, autoaugmentation was performed in 29 patients (18 girls and 11 boys) aged 4 – 13 years (median 8). Indication was neurogenic bladder with small capacity (no less than 60% of that expected for age) and poor compliance (myelomeningocele in 18, posterior urethral valve in 6, tethered cord in 3 and sacral agenesis in 2 patients). Detrusorectomy usually involved the whole upper half of the bladder. Prolapsed bladder urothelium was hitched to both rectus muscles to prevent its retraction and to offer easier bladder empting with muscle contractions. Of the 29 patients 22 participated, 3 was unavailable and 4 did not participated in complete evaluation.
Results: At the median follow-up of 27 months (ranged 9 to 49) bladder volume was increased significantly in all 22 patients and ranged from 190 to 462 mL (median, 322 mL). Now at the median follow-up of 133 months (ranged from 94 to 159), bladder volume ranged from 296 to 552 mL (median, 417 mL). All patients had a normal bladder compliance for age and confirmed continence. Voluntary voiding was achieved in 17 patients without residual urine; of 12 patients who used clean intermittent catheterization, only 5 was not able to empty bladder voluntary.
Conslusions: Detrusorectomy with rectus muscle hitch and backing can be used successfully for bladder autoaugmentation. This is minimally invasive, completely extraperitoneal, simple and safe to perform. Voluntary contractions of the rectus muscle enables bladder acting as “pseudodetrusor”. Main disadvantage is that this technique indicated only in selected cases with small bladder capacity and without anomaly of anterior abdominal wall.