gastrins and Hematuria

The problems encountered with ileal and colocystoplasty have led to the use of the stomach for bladder augmentation, termed gastrocystoplasty. The advantages of gastrocystoplasty over intestinal segment augmentation include reduced chloride reabsorption, decreased mucus production, decreased urinary infection in the presence of acid urine, extremely low incidence of stones, and avoidance of complications from short bowel syndrome. The gastric patch provides comparable improvements in bladder volume, pressure, and continence. The thick muscular wall of the stomach facilitates ureteric reimplantation as compared with the small intestine, but the rate of stenosis and reflux may not be superior. The disadvantages of the gastric patch include complications of severe systemic alkalosis, which is usually manifest in dehydrated, renal compromised patients, and the hematuria-dysuria syndrome (HDS), which is more prevalent in patients with renal insufficiency, normal pelvic sensation, and urinary incontinence. The postoperative complication rate of gastrocystoplasty is comparable with that of other augmentation procedures and similarly warrants proper selection and close follow-up of patients. In this report we review the literature and present the results, including a discussion of the technique and the pathophysiology of its complications.

Topics: Bacteriuria; Child; Gastrins; Hematuria; Humans; Neoplasms; Postoperative Complications; Stomach; Urinary Bladder; Urinary Diversion; Urinary Reservoirs, Continent; Urodynamics

To help determine the etiology and most appropriate treatment regimen for hypergastrinemia, dysuria-hematuria and metabolic alkalosis following augmentation gastrocystoplasty.. Two patients who presented with refractory metabolic alkalosis (1 with dysuria-hematuria) underwent extensive laboratory evaluation, complete upper gastrointestinal evaluation and intravesical pH probe placement.. Both patients eventually required high dose oral potassium chloride supplementation. Bladder mucosal pH was not reflected by buffered urinary pH. Both patients demonstrated significant gastroesophageal reflux and diminished overall gastric acid output.. Outpatient maintenance on potassium chloride supplementation may be warranted in select patients and appears to be preferable to histamine blockade or omeprazole. Postoperative screening esophagogastroscopy and an additional surgical maneuver might be indicated to prevent possible adverse sequelae of reflux esophagitis. Gastrocystoplasty may be an inappropriate operation in children with renal insufficiency who have not had metabolic acidosis.

Topics: Alkalosis; Child; Child, Preschool; Female; Gastric Mucosa; Gastrins; Hematuria; Humans; Male; Postoperative Complications; Stomach; Urinary Bladder