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De Win G, De Kort L, Learner H, Noah A, Dautricourt S, Nijman R, Stein R. Long-term risks of childhood surgery. J Pediatr Urol 2024; 20:165-172. [PMID: 37487882 DOI: 10.1016/j.jpurol.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Several patients, who underwent major reconstruction under the care of an experienced pediatric urologist are now, as adults, several years later, appearing with long term problems and complications. This consensus process was undertaken to give an overview of long term consequences (and their management) of urological childhood surgery. MATERIAL AND METHODS Several known urologists with experience in life-long follow up and revisional surgery of patients with congenital conditions were asked to review literature and comment based on their experience about several complications of childhood surgery. RESULTS Renal impairment, metabolic consequences, bladder stones, Vit B 12 deficiency and recurrent infections are often encountered. Also recurrent ureteric strictures and difficulties with catheterizable channel (both obstruction and incontinence) can be challenging to manage. Specific attention is needed regarding female sexuality and pregnancy. Both the development of malignancies in reconstructed bladders as secondary malignancies need to be taken into account during follow up. CONCLUSION Follow up of patients with rare congenital conditions is highly specialized and revisional surgery can be challenging. Therefore, follow up needs to be organized in specialized centers.
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Affiliation(s)
- Gunter De Win
- University Hospital Antwerp, Department of Urology, Edegem, Belgium; ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Adolescent & Congenital Lifelong Urology, University College London Hospitals, London, UK.
| | | | - Hazel Learner
- Adolescent Gynaecology, University College London Hospitals, London, UK
| | - Anthony Noah
- Adolescent & Congenital Lifelong Urology, University College London Hospitals, London, UK
| | | | - Rien Nijman
- Department of Pediatric Urology, University Medical Center Groningen, the Netherlands
| | - Raimund Stein
- Paediatric and Reconstructive Urology, University Hospital Mannheim, Germany
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Yang X, Pu Q, Wen Y, Zhao Y, Wang J, Xu P, Ma Y, Liu E, Lv L, Wen JG. Activation of the TGF-β1/Smads/α-SMA pathway is related to histological and functional changes in children with neurogenic bladder. Sci Rep 2022; 12:9285. [PMID: 35662268 PMCID: PMC9166803 DOI: 10.1038/s41598-022-13470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022] Open
Abstract
This research is to investigate the expression of the TGF-β1/Smads/α-SMA pathway and its effect on bladder histology and function in children with neurogenic bladder (NB). The bladder specimens from 10 children with NB and 8 children with vesicoureteral junction obstruction were collected into the NB and control groups. The expression of TGF-β1, Smad2, Smad3, Smad4, Smad6, α-SMA, fibronectin, collagen I and collagen III in bladder tissues was detected. In addition, the histological characteristics of the bladder were evaluated. A preoperative urodynamic study was performed on all children with NB. We analysed the correlations among the expression of the marker protein a-SMA in myofibroblasts, effector cells of the pathway, and bladder function parameters. Compared with those in the control group, the expression of TGF-β1, Smad2, Smad3, Smad4, α-SMA, fibronectin, collagen I and collagen III was significantly increased in the NB group, while the expression of Smad6 was decreased (p < 0.01). HE and Masson staining in the NB group showed increased collagen levels and hypertrophy of smooth muscle cells. Children with NB had a low bladder volume ratio (BVR), low compliance (△C) and high maximum bladder pressure, low maximum flow rate, large postvoid residual volume, low bladder contraction index and low bladder voiding efficiency. The expression of α-SMA was negatively correlated with the BVR (r = − 0.7066, P = 0.0223) and △C (r = − 0.6516, P = 0.0412). We conclude that the TGF-β1/Smads/α-SMA pathway is activated in the bladder tissue of children with NB and may be involved in the processes causing histological and functional changes.
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Affiliation(s)
- Xinghuan Yang
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Qingsong Pu
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Yibo Wen
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Yi Zhao
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Junkui Wang
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Pengchao Xu
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Yuan Ma
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Erpeng Liu
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Lei Lv
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China.,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China
| | - Jian Guo Wen
- Department of Pediatric Urodynamic Center, Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. .,Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, China. .,Urinary Bladder Structure and Function Reconstruction Laboratory (Henan Developing and Reform Committee), Zhengzhou, China.
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Delgado-Miguel C, Muñoz-Serrano A, Amesty V, Rivas S, Lobato R, Martínez-Urrutia MJ, López-Pereira P. Artificial urinary sphincter in congenital neuropathic bladder: Very long-term outcomes. Int J Urol 2022; 29:692-697. [PMID: 35340070 DOI: 10.1111/iju.14874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Artificial urinary sphincter has been used to treat urinary incontinence in children with neuropathic bladder, although there are few studies reporting very long-term results. We assess our experience over the last 27 years in the management of artificial urinary sphincter. METHODS A retrospective study was performed in patients with neuropathic bladder in whom an artificial urinary sphincter was placed in our institution between 1994 and 2020. Demographic variables, pre- and post-artificial urinary sphincter implantation urodynamic studies, long-term outcomes, and postoperative complications were collected. RESULTS An artificial urinary sphincter was implanted in 71 patients (median age 14.5; interquartile range 12.8-15.9), with a median follow-up time of 17.2 years (interquartile range 9.8-23.9 years). Thirty-nine patients underwent enterocystoplasty combined with artificial urinary sphincter placement and 32 underwent artificial urinary sphincter implantation alone, of whom 12 patients (16.9%) eventually required an enterocystoplasty because of unexpected bladder behavior changes, usually within 3 years of artificial urinary sphincter implantation. Adequate urinary continence was reported in 90.1% of patients, nine void their bladders spontaneously, and 62 need clean intermittent catheterization. Eighteen mechanical malfunctions occurred in 15 patients (21.1%), with an average artificial urinary sphincter working life of 15.1 ± 1.3 years. In five patients artificial urinary sphincter was removed due to infection or erosion. In 12 patients (30.8%), a continent catheterizable stoma was made (before or during the follow-up) because of problems with clean intermittent catheterization through the urethra. CONCLUSION The very long-term results of this study demonstrate that artificial urinary sphincter is an effective treatment for urinary incontinence in neuropathic bladder patients. Long-term follow-up is important to identify potential unexpected changes in bladder behavior in these patients.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain.,Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | - Antonio Muñoz-Serrano
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain.,Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | - Virginia Amesty
- Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | - Susana Rivas
- Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | - Roberto Lobato
- Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain
| | | | - Pedro López-Pereira
- Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain
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