Introduction ! Patients with a small or poorly compliant bladder secondary to malformation or neurogenic disor- ders should undergo a bladder augmentation (augmentation cystoplasty). This procedure pro- vides an adequate high-capacity reservoir with low bladder pressure and, in consequence, will preserve the kidneys and guarantee optimal uri- nary continence. Continent urinary diversion (CUD) has become the most widely used alternative mechanism to perform clean intermittent catheterization (CIC) and is particularly applicable in children due to its easy access, the minimal rate of complications and its acceptance by the patient [6,12,19]. In this article, we review our experience with these procedures in twenty-three patients with an emphasis on long-term follow-up, and we compare our results with those reported in the literature. Materials and Methods ! The records of 23 patients who underwent aug- mentation cystoplasty, CUD or both between the years 1994 and 2004 were reviewed retrospec- tively. We assessed the data of 12 girls and 11 boys aged between 15 months and 14 years. The underlying diagnosis was neurogenic bladder in 19 cases, posterior urethral valve in one case, bladder extrophy in two cases and female hypo- spadias in one case (l " Table 1). The surgical indi- cations for bladder augmentation (l " Table 2) in- cluded preparation for renal transplantation, re- pair of female hypospadias with severe voiding dysfunction, prevention of further upper tract deterioration or acute pyelonephritis despite medical treatment including CIC and oxybutynin, the absence of urinary continence despite clean intermittent catheterization and high-dose para- sympatholytic drugs, or previous bladder aug- mentation with a low bladder capacity based on Abstract ! Objective: We evaluated the success and the long-term complications associated with aug- mentation cystoplasty and/or continent urinary diversion in children with urinary incontinence due to neurogenic or malformed bladder. Materials and Methods: The records of 23 pa- tients (12 females, 11 males) who underwent such procedures between 1994 and 2004 were reviewed retrospectively. The most common type of augmentation cystoplasty was ileocystoplasty. The most common type of conduit for the urinary continent diversion was appendicovesicostomy. Combined bladder neck closure was not per- formed systematically. Neocystoureterostomy was done in 14 refluxing ureters. Results: Of the 21 patients who underwent aug- mentation cystoplasty, only one was incontinent after the procedure and required reconstruction of the bladder neck using the Young-Dees proce- dure. The most common complications were sto- mal stenosis and bladder stone formation. Conclusion: Augmentation cystoplasty and conti- nent urinary diversion procedures can increase the functional capacity of the small bladder and allow the majority of patients to achieve conti- nence while preserving renal function. Combined bladder neck closure is not necessary to obtain urinary continence; on the contrary, it eliminates a useful pop-off mechanism. Neocystouretrosto- my is not required for every refluxing ureter un- less it can be performed on the original bladder. Bladder stones and stomal stenosis are the most significant long-term complications in these pa- tients. Bladder Augmentation and/or Continent Urinary Diversion: 10-Year Experience Authors P. Daher 1,2 , S. Zeidan 1 , E. Riachy 1 , F. Iskandarani 1 Affiliations 1 Department of Pediatric Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon 2 Saint Joseph University, Beirut, Lebanon Key words l " bladder augmentation l " cystoplasty l " urinary diversion l " stomas l " postoperative complications Mots-clés l " agrandissement de vessie l " cystoplastie l " diversion urinaire l " stomies l " complications post opératoires Palabras clave l " ampliación vesical l " cistoplastia l " derivación urinaria l " estomas l " complicaciones postoperatorias Schlüsselwörter l " Blasenerweiterungsplastik l " Blasenplastik l " kontinente Harnableitung l " Stoma l " Komplikationen received June 6, 2006 accepted after revision July 12, 2006 Bibliography DOI 10.1055/s-2007-965027 Eur J Pediatr Surg 2007; 17: 119 – 123 © Georg Thieme Verlag KG Stuttgart • New York • ISSN 0939-7248 Correspondence Paul Daher, M.D. Associate Professor at Saint Joseph University Chairman of the Department of Pediatric Surgery Hotel Dieu de France Hospital Alfred Naccache Blvd, Ashrafieh Beirut Lebanon jmpaul@dm.net.lb 119 Daher P et al. Bladder Augmentation and/or… Eur J Pediatr Surg 2007; 17: 119 – 123 Original Article