Gastrocystoplasty: Long-term complications in 22 patients

Purpose: Gastrocystoplasty has been performed as an alternative to enterocystoplasty to increase bladder capacity and/or compliance while avoiding the complications associated with the use of bowel segments. Gastrocystoplasty is not without metabolic and physiological complications, such as the dysuria-hematuria syndrome and hypochloremic metabolic alkalosis. Currently to our knowledge there is limited long-term followup of gastrocystoplasty, which prompted us to review our experience with gastrocystoplasty and compare our findings with those of others. Materials and Methods: We retrospectively reviewed for complications the records of 12 boys and 10 girls 8 to 24 years old who underwent gastrocystoplasty. Followup ranged from 48 to 96 months. The diagnosis included neurogenic bladder in 12 cases, posterior urethral valves in 6, bladder exstrophy in 3 and pelvic tumor in 1. All patients underwent preoperative evaluation of serum electrolytes, blood urea nitrogen and creatinine as well as a radionuclide renal scan. Urodynamics were done preoperatively in all patients and postoperatively for complications. A gastric wedge with the pedicle based on the right gastroepiploic artery was removed, leaving the lesser curvature and vagus nerve intact. This technique was used in 21 of the 22 cases, including 1 case after initial surgery elsewhere. Ureteroneocystotomy, Mitrofanoff appendicovesicostomy and bladder neck reconstruction were performed as indicated. Results: There was 1 early complication (postoperative bleeding) and the remainder were late complications, including vesicoureteral reflux in 4 cases, Mitrofanoff valve stenosis in 3, the hematuria-dysuria syndrome, renal calculi, decreased bladder capacity with incontinence and metabolic alkalosis in 2 each, and ureterovesical stricture in 1. The late complication rate in our series was 36%. Conclusions: Our long-term results differ from those of others in the number of late complications (36 versus 21.8%). In addition, 50% of our patients with complications had multiple complications. These findings may be due to a longer followup. Nevertheless, our data cast serious doubt on the long-term advantages of using stomach for bladder augmentation.