Detrusorectomy with rectus muscle hitch and backing.

PURPOSE: Bladder autoaugmentation is a procedure that includes detrusoromyotomy or detrusorectomy with an aim to release intact urothelium, which then prolapses and increases bladder capacity and compliance. Covering of the prolapsed urothelium usually is done by using deepithelialized pedicled colonic or gastric patch. The authors present their first experiences with detrusorectomy using rectus muscle for hitch and backing. METHODS: Between August 1999 and February 2002, autoaugmentation was performed in 19 patients (12 girls and 7 boys) aged 4 to 12 years (median, 8). All patients had a neurogenic bladder with small capacity and poor compliance. Detrusorectomy usually involves the whole upper half of the bladder to achieve regular shape of the huge prolapsed urothelium. Both rectus muscles are dissected from their anterior and posterior sheaths. Urothelium is sutured to the muscle at several points to prevent its retraction and shrinkage. This way, bladder is fixed and hanged on rectus muscles. RESULTS: Follow-up was 6 to 35 months (median, 21). The new bladder capacity was increased in all patients and ranged from 190 to 411 ml (median, 313). All patients had clinical improvement and better compliance. CONCLUSIONS: Detrusorectomy with rectus muscle hitch and backing is a safe and simple procedure. However, long-term results are needed to define value of this procedure.

Bladder autoaugmentation with rectus muscle backing.

PURPOSE: Bladder autoaugmentation is a procedure which includes detrusoromyotomy or detrusorectomy to release intact urothelium which than prolapses and increases bladder capacity and compliance. The prolapsed urothelium is usually covered with de-epithelialized pedicled colonic or gastric patch. We present our initial experience with bladder autoaugmentation using rectus muscle backing. MATERIALS AND METHODS: Between August 1999 and December 2000 autoaugmentation was performed in 4 girls and 3 boys 4 to 11 years old (median age 8). All patients had neurogenic bladder with small capacity and poor compliance. The technique is performed using an extraperitoneal approach through either an inferior midline longitudinal or transverse incision. The procedure is started with a semi-filled bladder to find the right plane and then continues with an almost empty bladder to avoid severe injury of the prolapsed urothelium. Both rectus muscles are dissected from the anterior and posterior sheaths and sutured to detrusor edges. Urothelium is sutured to the muscle at several places to prevent its retraction and shrinkage. Thus, the bladder is fixed and hangs on rectus muscles, that is the anterior abdominal wall. RESULTS: Followup was 10 to 25 months (median 16). Bladder capacity at 6 months postoperatively increased in all patients, and ranged from 162 to 368 ml. (median 266). All patients had clinical improvement, decreased hydronephrosis, no vesicoureteral reflux and better compliance. CONCLUSIONS: Bladder autoaugmentation with rectus muscle backing is a safe and simple procedure. Rectus muscle is a good alternative to other backing materials.

Penile surgery and reconstruction.

This review will highlight recent advances in the field of penile reconstructive surgery in the paediatric and adult population. It is based on the work published during the year 2001. Besides the anatomical and histological studies of the penis, major contributions have been described in congenital and acquired penile anomalies. Also, a few new techniques and modifications of old procedures are described in order to improve the final functional and aesthetic outcome. The techniques for penile enlargement present a trend in the new millennium, but are still at the stage of investigation.