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Juhász ZS, Kispál Z, Kardos D, Vajda P. Long-term urodynamic findings following colo-, gastro- and ileocystoplasty. Pediatr Surg Int 2024; 40:131. [PMID: 38730091 DOI: 10.1007/s00383-024-05714-z] [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] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE To evaluate the urodynamic changes in patients who have undergone colocystoplasty (CCP), gastrocystoplasty (GCP) and ileocystoplasty (ICP) in a retrospective study. Changes in urinary continence, incidence of pathologic contractions before and after augmentation, alterations of urodynamic parameters were also examined. METHODS Eighty-four patients were included in the study who underwent bladder augmentation between 1987 and 2017. Group I: 35 patients with CCP. Group II: 18 patients with GCP. Group III: 31 patients with ICP. Cystometry was performed at 3, 6, and every 12 months, then biannually after augmentation. Pre- and postoperative urodynamic changes were analysed statistically. RESULTS In Group I, two patients and in Group III, one patient remained incontinent after CCP and ICP. Bladder capacity increased significantly, maximal intra-vesical pressure decreased and compliance improved in all groups (p < 0.001). Postoperative studies showed pathologic contractions in the augmented bladder in half of the patients with GCP, in 43% of patients after CCP and 26% of patients with ICP. CONCLUSION From the urodynamic point of view, ileum is the most adequate option in the long term. Contractions after augmentation might be caused by the remaining peristalsis of the detubularised segment. Further investigations are needed to evaluate pathologic contractions that remained after detubularisation.
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Affiliation(s)
- Z S Juhász
- Medical School, Department of Pediatrics, Surgical Division, University of Pécs, 7 József Attila Street, Pécs, 7623, Hungary
| | - Z Kispál
- Department of Paediatric Surgery, Petz Aladár University Teaching Hospital, 2-4 Vasvári Pál Street, Győr, 9023, Hungary.
| | - D Kardos
- Medical School, Department of Pediatrics, Surgical Division, University of Pécs, 7 József Attila Street, Pécs, 7623, Hungary
| | - P Vajda
- Medical School, Department of Pediatrics, Surgical Division, University of Pécs, 7 József Attila Street, Pécs, 7623, Hungary
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Chang JW, Kuo FC, Lin TC, Chin TW, Yang LY, Chen HH, Fan YH, Yang HH, Liu CS, Tsai HL. Long-term complications and outcomes of augmentation cystoplasty in children with neurogenic bladder. Sci Rep 2024; 14:4214. [PMID: 38378755 PMCID: PMC10879155 DOI: 10.1038/s41598-024-54431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
Augmentation cystoplasty (AC) is an effective surgical procedure for patients with neurogenic bladder whenever conservative treatments have failed. The present study aimed to determine the risks of metabolic complications, malignancy, long-term outcomes and histopathologic changes of native bladder and the augmented intestine after AC in children with neurogenic bladder. Pediatric patients < 18 years who underwent AC between 2000 and 2020 were enrolled. Early postoperative complications, long-term outcomes and histopathologic changes in mucosal biopsies of native bladder and the augmented intestine after AC were reviewed. Twenty-two patients with a mean age of 7.6 ± 4.4 years were included. The ileum was used in 19 patients and the sigmoid colon in 3 patients. The length of hospital stay was 14.8 ± 6.8 days. Post-operatively, the urinary continence rate improved from 22.7 to 81.8% (p < 0.001). Hydronephrosis resolved in 17 of 19 patients. Vesicoureteral reflux resolved in 16 (64.0%) of the refluxing ureter units and was downgraded in 7 (28.0%). Grades of hydronephrosis and reflux significantly improved following AC (p < 0.001). The estimated glomerular filtration rate also significantly increased (p = 0.012). Formation of urinary tract stones was the most frequent late complication (in 8 patients, 36.4%). Life-threatening spontaneous bladder perforation occurred in 1 patient. After a mean follow-up of 13.4 ± 5.9 years, there were no cases of mortality, new-onset symptomatic metabolic acidosis, or changes in serum electrolytes. Of the 17 patients who were followed for > 10 years, no cases of malignancy or metaplastic changes were identified in the native bladder or augmented bowel epithelium. AC is a safe and effective procedure with low surgical and metabolic complication rates. In addition, AC provides a satisfactory continence rate and long-term protection of renal function, increases functional capacity, and regresses reflux and hydronephrosis. Individualized surveillance is recommended for the early identification of urolithiasis and metabolic disturbances.
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Affiliation(s)
- Jei-Wen Chang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Cheng Kuo
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Tzu-Ching Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tai-Wai Chin
- Department of Pediatric Surgery, Changhua Christian Children Hospital, Changhua, Taiwan
| | - Ling-Yu Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Hung Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hua Fan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Hsin Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Chin-Su Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Hsin-Lin Tsai
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan.
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Urbán D, Cserni T, Boros M, Juhász Á, Érces D, Varga G. Bladder augmentation from an insider's perspective: a review of the literature on microcirculatory studies. Int Urol Nephrol 2021; 53:2221-2230. [PMID: 34435307 DOI: 10.1007/s11255-021-02971-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023]
Abstract
Augmentation cystoplasty is an exemplary multiorgan intervention in urology which is particularly associated with microvascular damage. Our aim was to review the available intravital imaging techniques and data obtained from clinical and experimental microcirculatory studies involving the most important donor organs applied in bladder augmentation. Although numerous direct or indirect methods are available to assess the condition of microvessels the implementation of microcirculatory diagnostic methods in humans is still challenging and the assessment of organ microcirculation in the operating theatre has limitations. Nevertheless, preclinical studies generally report good internal validity and although prospective human protocols with reduced variability are needed, a possible positive impact of microcirculatory diagnostics on the clinical outcomes of urologic surgery can be anticipated.
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Affiliation(s)
- Dániel Urbán
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary.,Department of General and Thoracic Surgery, Hetényi Géza County Hospital, Tószegi u. 21., Szolnok, 5000, Hungary
| | - Tamás Cserni
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary.,Department of Paediatric Urology, The Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Mihály Boros
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary
| | - Árpád Juhász
- Department of General and Thoracic Surgery, Hetényi Géza County Hospital, Tószegi u. 21., Szolnok, 5000, Hungary
| | - Dániel Érces
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary
| | - Gabriella Varga
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary.
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Tran THT, Melamed J, Deng FM. Gastric Adenocarcinoma Arising in Gastrocystoplasty. Urology 2020; 148:270-273. [PMID: 32683064 DOI: 10.1016/j.urology.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 11/18/2022]
Abstract
Gastric cancer is a rare long-term complication in gastrocystoplasty. We report 2 cases of gastric adenocarcinoma and review the literature for similar cases. A total of 14 cases are identified. The majority of patients are males, presented with hematuria, and developed cancer at a younger age, more than 10 years after gastrocystoplasty. Long-term follow up information was limited, but 5 patients (36%) died within 5 years of diagnosis. Annual surveillance for malignancy may not be effective due to its rarity. However, symptomatic patients, particularly those 10 years after the surgery, warrant detailed evaluation to rule out neoplastic transformation.
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Affiliation(s)
- Tuyet Hong T Tran
- Department of Pathology, New York University Langone Health, New York, NY
| | - Jonathan Melamed
- Department of Pathology, New York University Langone Health, New York, NY
| | - Fang-Ming Deng
- Department of Pathology, New York University Langone Health, New York, NY.
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