Bladder augmentation with continent stoma formation in case of a urological and gynaecological complex congenital developmental disorders
DOI: 10.22591/magyurol.2025.1.reparukj.22
Authors:
Repáruk József dr.1, Majoros Attila dr.2, Keszthelyi Attila dr.2
1Zala Vármegyei Szt. Rafael Kórház, Urológiai Osztály, Veszprém (osztályvezető: Kozma-Bognár Tamás dr.)
2Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
Summary
Introduction: Bladder exstrophy is a congenital developmental anomaly recognized at birth, often associated with abnormalities in other organs. Early reconstruction is essential; however, nearly half of the patients who undergo surgery may later experience urological and/or fertility complications. One such complication is neurogenic bladder dysfunction. While less invasive treatments exist, bladder augmentation is more frequently chosen in younger patients for its more durable outcomes.
Case report: A 24-year-old female patient presented at the Semmelweis University Urology Clinic with complaints of complete incontinence. Her medical history included multiple developmental anomalies: bladder exstrophy, epispadias, sphincter insufficiency, renal agenesis, vaginal duplex, uterus bicornis, rudimentary appendix, late-closing foramen ovale, complex morphological abnormalities of the spine and pelvic bones, and supernumerary fingers. She underwent multi-stage reconstructive surgery during childhood. Urodynamic studies confirmed reduced bladder capacity, detrusor hyperactivity, and sphincter insufficiency. The treatment plan included bladder augmentation and the creation of a catheterizable continent abdominal stoma. The patient’s rudimentary appendix was unsuitable for creating a Mitrofanoff stoma. Therefore, after bladder augmentation, a catheterizable urinary stoma was created from the oral end of the isolated ileal segment. The surgery was complication-free and resolved her urological dysfunctions, although reconstruction of the gynaecological organs remains pending.
Conclusions: In cases of neurogenic lower urinary tract dysfunction arising from bladder exstrophy, bladder augmentation using an isolated intestinal segment and the creation of a catheterizable continent abdominal stoma is a viable and effective treatment option, especially for younger patients.