Augmentation Cystoplasty in Children: Institute of Kidney Diseases Peshawar Experience

Rapid Communication

Austin J Urol. 2021; 7(1): 1066.

Augmentation Cystoplasty in Children: Institute of Kidney Diseases Peshawar Experience

Muhammad Naeem, Muhammad Kamran Khan*, Arshad, Majid Khan, Mehboob ul Wahab, Ihsanullah

Department of Urology, Institute of Kidney, Peshawar, Pakistan

*Corresponding author: Muhammad Kamran Khan, Assistant Professor of Pediatric Urology, Institute of Kidney Diseases, Peshawar, Pakistan

Received: May 11, 2021; Accepted: June 07, 2021; Published: June 14, 2021


Objective: The aim of this study is to share our single-center experience of Augmentation Cystoplasty (AC) in children regarding indications, bowel segment used, associated procedures, and its complications.

Materials and Methods: We analyzed data of all pediatric patients who underwent AC at Institute of Kidney Diseases (IKD), Peshawar between July 2017 and March 2020.

Results: A total of 18 pediatric patients are included in the study who underwent Bladder augmentation (BA) either isolated in 1 (5.5%), or along with other associated procedures like Mitrofanoff 17 (94.4%), Antegrade Continent Enema (ACE) 6 (33.3%), Bladder Neck Reconstruction (BNR) 5 (27.7%) and Bilateral ureteric Re-implantation (B/L UR) in 3 (16.6%). Indication for Bladder augmentation were Neurogenic bladder (NGB) 13 (72.2%), Exstrophy Epispadias Complex (EEC) 3 (16.6%) and Posterior urethral value with small functional capacity bladder 2 (11.1%). Small gut used in 15 (83.3%) and large gut in 3 (16.6%) for BA. For Mitrofanff associated with bladder augmentation, Appendix was used in 14 (82.35%) and small gut (Monti) in 3 (17.6%) cases. For ACE associated with BA, in 4 (66.6%) Appendix used as right-sided ACE and in 2 (33.3%) small gut (Monti) as left-sided ACE. No intraoperative complications noted, while early post-op complications, 2 wound infection and 1 urinary leakage from wound, were noted in 3(16.6%) cases and late post-op complications (stomal stenosis) in 4(22.2%) patients.

Keywords: Augmentation cystoplasty; Mitrofanoff; Antegrade continent enema; Neurogenic bladder; Exstrophy epispadias complex; Mitrofanoff stenosis

Abbreviations and Acronyms

AC: Augmentation Cystoplastyl; Mit: Mitrofanoff; ACE: Antegrade Continent Enema; BNR: Bladder Neck Reconstruction; B/L UR: Bilateral Ureteric re-implantation; IKD: Institute of Kidney Disease; HMC: Hayatabad Medical Complex; NGB: Neurogenic Bladder; NGBB: Neurogenic Bladder and Bowel; EEC: Exstrophy Epispadias Complex.


Fecal and urinary incontinence in spina bifida patient is one of the most devastating condition of the children. It has both social and psychological implications and decreased quality of life along with other comorbidities. Most of these patients are treated with various types of enemas to clean out the colon for bowel management and clean intermittent catheterization with or without anticholinergic medications for bladder management. When conservative measures of medication and clean intermittent catheterization fails in the management of Neurogenic bowel and bladder then surgical treatment is opted which includes botulinum toxin to the detrusor, continent catheterizable conduit with or without bladder augmentation [1-3].

AC is considered in the pediatric population for lower urinary tract reconstruction in cases of congenital urological anomalies like Neurogenic Bladder (NGB) associated with spina bifida as last resort when conservative measures and other minimally invasive measures like intradetrussor botulinum toxin have failed . In such cases, the bladder is augmented with viscoelastic tissue, commonly autogenous gastrointestinal segment. This increases bladder capacity and decreases the bladder pressures, thereby protecting the upper tract and also helps in improving the continence and symptoms [4]. AC is a good option with a reasonable satisfaction rate and good long term outcomes including improvement in symptoms and continence in both neurogenic and non-neurogenic bladder dysfunction [5-7]. It also improves urodynamic parameters and associated with variable rate of clean intermittent catheterizations [8].

International Consultation on Incontinence also recommend BA for reduced bladder capacity and compliance and detrusor over activity when other treatment options like medical treatment, Botulinum toxin injection, and/or neuromodulations have failed [7]. According to European Association of Urology guidelines, BA is recommended to decrease detrusor pressure and increase bladder capacity, in case of failure of more conservative options [9]. If patient are not able to perform the transurethral intermittent catheterization, Mitrofannof either using Appendix or small gut (Monti) channel is created to drain the bladder [10,11].

The aim of this study was to share our experience of AC for bladder dysfunction associated with neurogenic and non neurogenic bladders. We wanted to see the safety and efficacy of the technique, indications for the AC, bowel segment used and the complications associated with the procedure.

Materials and Methods

Between July 2017 and March 2020, after the institute ethical committee approval, all pediatric patients record who underwent BA were retrospectively identified. Total of 18 patients who underwent BA either alone or associated with other procedures including Mitrofanoff, Antegrade Continent Enema (ACE), Bladder Neck Reconstruction (BNR) at our institution were included in the study. Patient records were accessed through an institutional medical record system. Statistical analyses was performed with IBM® SPSS®, version 20.0.


A total of 18 patients with mean age of 9.5 years identified, which included 10 (55.6%) female and 8 (44.4%) male patients. They underwent AC (Immediate Post Op Picture, Figure 1) either isolated or along with other procedures like Mitrofanoff, Antegrade continent enema, Bladder neck reconstruction, between July 2017 and March 2020. The details of the procedures performed in these patients are shown in Table 1. The indications of AC in these patients are given in Table 2.