enterocystoplasty in children: a review. J Urol 2005; 173: 1080. 23. Lopez PP, Moreno Valle JA, Espinosa L et al: Enterocystoplasty in children with neuropathic bladders: long-term follow-up. J Pediatr Urol 2008; 4: 27. 24. Cartwright PC and Snow BW: Bladder autoaugmentation: early clinical experience. J Urol 1989; 142: 505. 25. Perovic SV, Djordjevic ML, Kekic ZK et al: Detrusorectomy with rectus muscle hitch and backing. J Pediatr Surg 2003; 38: 1637. 26. Stothers L, Johnson H, Arnold W et al: Bladder autoaugmentation by vesicomyotomy in the pediatric neurogenic bladder. Urology 1994; 44: 110. 27. Snow BW and Cartwright PC: Bladder autoaugmentation. Urol Clin North Am 1996; 23: 323. 28. Oge O, Tekgul S, Ergen A et al: Urothelium- preserving augmentation cystoplasty covered with a peritoneal flap. BJU Int 2000; 85: 802. 29. Close CE, Dewan PA, Ashwood PJ et al: Autoaugmentation peritoneocystoplasty in a sheep model. BJU Int 2001; 88: 414. 30. Dewan PA: Autoaugmentation demucosalized enterocystoplasty. World J Urol 1998; 16: 255. EDITORIAL COMMENT The authors suggest speciﬁc steps that may lead to a better outcome from autoaugmentation, including patient selection, hitching the bladder and cycling postoperatively. Certainly for ureterocystoplasty selection is paramount in deciding which in- dividuals are suitable for autoaugmentation, ie the ureter has to be large enough and a bladder that is considered for autoaugmentation should be 50% of age expected volume. We found that autoaugmentation failed, usually resulting in a smaller bladder, despite omental or peritoneal backing (reference 29 in article). 1 We also note a clear advantage to supporting the urothelium with demucosalized muscle (reference 30 in article). The results of this series indicate that “some” patients can do extremely well with autoaugmentation alone. However, to ensure that we are making a difference with surgical intervention, careful prospective evaluation of the individual outcomes of autoaugmentation is essential. It is noteworthy that 7 of 21 patients in this series had either a small bladder or a minimal increase in bladder volume on ﬁnal review. In addition, signif- icant other interventions were undertaken in a number of patients. I would caution that we be guarded as to what we consider as “long-term” outcome for bladder augmentation innovations, and highlight the need for ongoing laboratory research into bladder enlargement technology. Paddy Dewan Department of General Surgery Royal Children’s Hospital Victoria, Australia REFERENCE 1. Dewan PA, Owen AJ, Stefanek W et al: Late follow up of autoaugmentation omentocystoplasty in a sheep model. Aust N Z J Surg 1995; 65: 596. LONG-TERM OUTCOME OF BLADDER AUTOAUGMENTATION 1875

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LONG-TERM OUTCOME OF BLADDER AUTOAUGMENTATION 1875

enterocystoplasty in children: a review. J Urol2005; 173: 1080.

23. Lopez PP, Moreno Valle JA, Espinosa L et al:Enterocystoplasty in children with neuropathicbladders: long-term follow-up. J Pediatr Urol2008; 4: 27.

24. Cartwright PC and Snow BW: Bladder autoaug-mentation: early clinical experience. J Urol 1989;142: 505.

25. Perovic SV, Djordjevic ML, Kekic ZK et al:Detrusorectomy with rectus muscle hitch andbacking. J Pediatr Surg 2003; 38: 1637.

26. Stothers L, Johnson H, Arnold W et al: Bladderautoaugmentation by vesicomyotomy in thepediatric neurogenic bladder. Urology 1994;44: 110.

27. Snow BW and Cartwright PC: Bladder autoaug-mentation. Urol Clin North Am 1996; 23: 323.

28. Oge O, Tekgul S, Ergen A et al: Urothelium-preserving augmentation cystoplasty coveredwith a peritoneal flap. BJU Int 2000; 85: 802.

29. Close CE, Dewan PA, Ashwood PJ et al:Autoaugmentation peritoneocystoplasty in asheep model. BJU Int 2001; 88: 414.

30. Dewan PA: Autoaugmentation demucosalizedenterocystoplasty. World J Urol 1998; 16: 255.

EDITORIAL COMMENT

The authors suggest specific steps that may lead to making a difference with surgical intervention,

a better outcome from autoaugmentation, includingpatient selection, hitching the bladder and cyclingpostoperatively. Certainly for ureterocystoplastyselection is paramount in deciding which in-dividuals are suitable for autoaugmentation, ie theureter has to be large enough and a bladder thatis considered for autoaugmentation should be 50%of age expected volume.

We found that autoaugmentation failed, usuallyresulting in a smaller bladder, despite omental orperitoneal backing (reference 29 in article).1 We alsonote a clear advantage to supporting the urotheliumwith demucosalized muscle (reference 30 in article).

The results of this series indicate that “some”patients can do extremely well with autoaugmen-tation alone. However, to ensure that we are

careful prospective evaluation of the individualoutcomes of autoaugmentation is essential. It isnoteworthy that 7 of 21 patients in this series hadeither a small bladder or a minimal increase inbladder volume on final review. In addition, signif-icant other interventions were undertaken in anumber of patients. I would caution that we beguarded as to what we consider as “long-term”outcome for bladder augmentation innovations, andhighlight the need for ongoing laboratory researchinto bladder enlargement technology.

Paddy DewanDepartment of General Surgery

Royal Children’s Hospital

Victoria, Australia

REFERENCE

1. Dewan PA, Owen AJ, Stefanek W et al: Late follow up of autoaugmentation omentocystoplasty in a sheep model. Aust N Z J Surg 1995; 65: 596.