Bladder augmentation using the stomach in spinal cord injured patients with impaired renal function.

Abstract

A small capacity, poorly compliant neurogenic bladder is a difficult problem in spinal cord injured patients. Bladder augmentation with intermittent catheterization offers an alternative to indwelling catheterization. Ileum, cecum, and sigmoid colon have been most commonly used for enterocystoplasty but may, however, cause hyperchloremic metabolic acidosis in patients with impaired renal function. This can be prevented by performing a gastric augmentation. We present two cases of gastrocystoplasty in spinal cord injured patients with a small capacity, poorly compliant neurogenic bladder, impaired renal function, vesicoureteral reflux, and recurrent febrile urinary tract infections. Both patients had bilateral ureteral reimplantations during the surgery. One of the patients, a women, had a destroyed urethral sphincter secondary to long-term Foley that was repaired with a concurrent pubovaginal sling. Follow-up ranges from 12 to 18 months and both patients are continent with intermittent catheterization and have bladder capacities over 500 mL. Neither patient had deterioration in renal function or changes in serum electrolytes. Both patients maintain a slightly acidic urine and neither patient has had a clinically apparent urinary tract infection.