Bladder autoaugmentation by vesicomyotomy in the pediatric neurogenic bladder

The authors describe the procedure of bladder autoaugmentation by vesicomyotomy in 12 pediatric patients with neurogenic bladders. Indications for augmentation included low-capacity, high-pressure bladders with incontinence despite maximal anticholinergic therapy. Clean intermittent catheterization was successfully reinstituted postoperatively and no patient has subsequently required enterocystoplasty. There were no major complications and eight patients underwent concurrent procedures on the bladder. Urodynamic studies revealed a mean increase in capacity of 40% and a mean decrease in leak point pressure of 33% compared with preoperative values. Early clinical experience would suggest that vesicomyectomy (excision of released detrusor) offers no advantages over vesicomyotomy in pediatric patients. Vesicomyotomy (simple incision into detrusor) proved to be a simple technique that could be safely performed in pediatric patients.