A CASE OF URINARY UNDIVERSION

Preoperative Bladder Evaluation by Cyclic Bladder Hydrodilation

Abstract

A sixteen-year-old boy, whose ureters had been diverted by ureterocutaneostomy 10 years earlier, underwent a urinary undiversion with bilateral end ureteroureterostomy.
A small capacity of 30ml and bilateral reflux in ureteral stumps were the preoperative findings. Cyclic bladder hydrodilation through a suprapubic cystostomy was effective in increasing the bladder capacity gradually and eradicating the bilateral reflux. Micturition was perfect without residue or incontinence. We believe cyclic bladder hydrodilation is useful for accurately observing voiding ability and continence before undiversion and for predicting whether augmentation cystoplasty or ureteral reimplantation are necessary during undiversion.
Because of repeated previous bowel surgeries, bilateral end ureteroureterostomy associated with mobilization and downward displacement of the kidneys was the choice of treatment through retroperitoneal approach. The stenosis, developed at the site of ureteral anastomosis in the right side, necessitated an indwelling of a double-J ureteral stent for 5 months. He is doing well 12 months after undiversion, with stable renal function and good urination. His daily life has been much improved.