Perforation of the augmented urinary bladder in nine children and adolescents: importance of cystography.

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Abstract
Augmentation of the urinary bladder is a popular surgical procedure for increasing the capacity and lowering the intraluminal pressure in patients whose bladder is small, noncompliant, or has high pressure. Among 250 augmentations performed at our hospital, nine patients have had 16 episodes of postoperative extravasation of urine from their augmented bladder. Thirteen episodes were studied by fluoroscopically monitored contrast cystography, which was diagnostic in 12. One patient's perforation was noted during an unrelated operation and the other two died of peritonitis before cystography could be performed. Four episodes occurred early, within 3 weeks of surgery. All were at a surgical anastomosis and presumably represented incomplete healing. Each patient with an early episode of extravasation had a perforation later. Nine perforations occurred from 1.0 to 6.5 months after the augmentation. Of these, three occurred at an anastomosis and four occurred in the augmenting segment. The locations of two were never fully documented. Three perforations occurred late, from 2.5 to 6.0 years after surgery, and all were in the augmenting segment. Three of the nine patients died of complications associated with perforation. Perforation of the bladder is not rare and is a potentially fatal complication of augmentation. Whenever a patient who has undergone augmentation has signs or symptoms suggesting perforation, cystography can play a crucial role in diagnosis and should be performed without delay.

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