L Skobejko-Wlodarska | PubMed Health

PubMed2000

Complete duplication of the bladder, urethra, vagina, and uterus in girls.

UNLABELLED: OBJECTIVES. To present our experience with 3 girls with complete duplication of the bladder, urethra, vagina, and uterus, a very rare anomaly, and review published reports. Associated anomalies in these cases represent a wide spectrum. METHODS: We report 3 girls with complete duplication of the bladder, urethra, vagina, and uterus. The associated anomalies were different in each child. The first patient had a symphysis diastasis creating an abdominal hernia with two bladders dislocated into this space. The second patient had anal atresia with colon duplication. The third had cloacal exstrophy with one opened bladder and a second closed, with persistent urogenital sinus. Each patient was carefully evaluated, but the anatomy in 2 patients was not completely defined until surgical exploration. RESULTS: Each girl underwent surgical repair. In the first patient, iliac osteotomy, approximation of the symphysis pubis, and excision of the hernia was done. In the second, excision of the common wall between the two descending colons and posterior sagittal anorectoplasty were performed. In the third patient, staged reconstruction of the cloacal exstrophy with anastomosis of the bladders and vaginas was done. CONCLUSIONS: Complete duplication of the urogenital system in girls is associated with different anomalies. Which surgical procedures will be required depends on the multiple anatomic variables.

Abnormalities, Multiple↗

PubMed1998

Bladder autoaugmentation in myelodysplastic children.

OBJECTIVE: To present the long-term results of bladder autoaugmentation in myelodysplastic children with low compliance neurogenic bladders who failed attempts at medical management, including clean intermittent catheterization (CIC) and pharmacological bladder relaxation. PATIENTS AND METHODS: Twenty-one patients with a neurogenic bladder after myelomeningocele operations (mean age 9.5 years, range 3-16) underwent autoaugmentation; 12 children were paraplegic and hydrocephalic, and were treated by insertion of a ventriculoperitoneal valve. All patients had low-compliance neurogenic bladders confirmed urodynamically. Ten patients had vesico-ureteric reflux (VUR) and eight had dilated upper urinary tracts with no reflux. All patients had been treated pre-operatively using CIC and anticholinergic agents, with no success. RESULTS: Of 21 children treated surgically, 17 were assessed urodynamically and examined to determine the condition of the upper and lower urinary tract. The follow-up ranged from 3 months to 8 years (mean 6 years). In 13 patients the bladder capacity increased by approximately 60 mL and in 14 the intravesical pressure decreased by approximately 65 cmH2O. Fourteen children were continent using CIC (from 3- to 4-hourly); in the six patients with VUR the reflux resolved in two, decreased in two and remained unchanged in two. Of eight patients with dilated upper tracts but no reflux, seven improved. There was no improvement in bladder capacity in four patients and no reduction in intravesical pressure in three. Two patients underwent enterocystoplasty (one ileocystoplasty and one colocystoplasty) with good results. Two children needed anticholinergic agents after autoaugmentation. CONCLUSIONS: Autoaugmentation effectively reduces high intravesical pressure and provides a sufficient increase in bladder capacity with a concomitant improvement in urodynamic values. The present method allows the extent of the surgical procedure to be limited to the extraperitoneal space and thus maintains all of other options. Bladder autoaugmentation is a reasonable alternative to enterocystoplasty in selected patients.

Adolescent↗