Results of urinary tract reconstruction in boys with end stage bladders resulting from obstructive uropathy

Purpose: The records of 17 boys who underwent reconstruction of the lower urinary tract because of end stage bladders resulting from obstructive uropathy were reviewed to evaluate the degree to which they void and factors that favorably impacted outcome. Materials and Methods: A total of 17 boys with end stage bladders resulting from obstructive uropathy, including posterior urethral valves in 15 and obstructing ureteroceles in 2, underwent reconstruction of the urinary tract. Procedures consisted of augmentation (autoaugmentation in 3, ileocystoplasty in 2, ileocecal cystoplasty in 1 and colocystoplasty in 10), an ileal ureter in 2, bladder neck revision in 15 and appendicovesicostomy in 8. Results: All patients achieved a low pressure reservoir of adequate volume with stable or improved urinary tracts. A total of 18 patients voided sufficiently well to maintain a favorable life- style, including 5 who were completely catheter-free. With respect to the variables involved in reconstruction, bladder neck revision seemed to correlate best with a good outcome. Conclusions: In most cases end stage bladders in boys with obstructive uropathy can be reconstructed not only to protect the urinary system, but to preserve some degree of voiding potential as well. Bladder neck revision appears to be particularly helpful in achieving the latter goal. When voiding is inadequate, appendicovesicostomy provides easy access to the bladder for intermittent catheterization.