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Silverii H, Merguerian P, Fernandez N, Smith J, Shnorhavorian M, Ahn J. Posterior urethral valves and kidney transplantation: Identifying opportunities for improvement. J Pediatr Urol 2024; 20 Suppl 1:S58-S65. [PMID: 38969556 DOI: 10.1016/j.jpurol.2024.06.022] [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: 04/01/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Posterior urethral valves (PUV) represents a heterogenous spectrum in which guidelines for management are lacking particularly for those patients facing end-stage kidney disease and transplant. In this study we aim to 1) evaluate our long term PUV pediatric transplant outcomes compared to those without lower urinary tract dysfunction and 2) assess our PUV cohort for trends in bladder management and evaluate outcomes to inform development of institutional guidelines. MATERIALS AND METHODS A retrospective cohort analysis of all patients with a diagnosis of PUV who underwent kidney transplant from 2000 to 2023 was completed. A matched cohort of patients without lower urinary tract dysfunction was identified for comparison of graft function. Charts of PUV patients were reviewed for both sociodemographic and clinical variables. Patients were classified by bladder management at the time of transplantation into three separate groups for analysis: voiding, clean intermittent catheterization, and incontinent diversion. Primary outcomes of interest were eGFR, graft failure, and UTIs post-transplant. RESULTS 45 patients met inclusion criteria. 69% were on dialysis prior to transplant. 51% of grafts were from a deceased donor. Bladder management consisted of voiding (62%), CIC (4 via urethra, 10 via channel) (31%), and incontinent diversion (7%). 20% underwent augmentation cystoplasty (5 = ureter, 2 = gastric, 1 = colon, and 1 = ileum) prior to or at the time of transplant. Median follow up duration was 5.4 years (3.0, 10.8). Patients on CIC had higher rates of UTI; however, we found no significant difference in graft function outcomes (eGFR, graft failure) between bladder management groups or year of transplant. VUR in the transplant kidney was associated with vesicostomy (p = 0.028). 2 of 2 gastric augments developed malignancy, one of which was cause of death. Graft failure rate was 22% in both the PUV group and matched cohort, with median interval times to failure of 6.7 years and 3.7 years, respectively (p = 0.71). There were no differences in eGFR at follow-up time points between the PUV and matched cohort. CONCLUSIONS Patients with PUV represent a spectrum of disease with heterogeneous management before and after kidney transplant. Overall, graft function outcomes were similar when compared to matched cohort without lower urinary tract dysfunction. Patients on CIC had higher rates of UTI but without impact on graft function. Gastric augmentation cystoplasty should be avoided given risk for malignancy. Guidelines to standardize evaluation and management would be helpful for patient care and outcomes.
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Affiliation(s)
- Hailey Silverii
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE 98105, United States; University of Washington, Department of Urology, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Paul Merguerian
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE 98105, United States; University of Washington, Department of Urology, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - Nicolas Fernandez
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE 98105, United States; University of Washington, Department of Urology, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - Jodi Smith
- Seattle Children's Hospital, Division of Nephrology, 4800 Sand Point Way NE 98105, United States
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE 98105, United States; University of Washington, Department of Urology, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - Jennifer Ahn
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE 98105, United States; University of Washington, Department of Urology, 1959 NE Pacific Street, Seattle, WA 98195, United States
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Roth JD, Miller MA, O'Neil JO, Wiener JS, Wood HM. Transitioning young adults with spina bifida: Challenges and paths to success. J Pediatr Urol 2024; 20:200-210. [PMID: 37788943 DOI: 10.1016/j.jpurol.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION AND BACKGROUND Recent medical advances, including closure of myelomeningocele defects, shunting of hydrocephalus, and focusing on renal preservation have led to many individuals with spina bifida (SB) living into adulthood. This has led to more individuals with SB transitioning their care from pediatric-based to adult-based care models. OBJECTIVE We seek to explore the process of transition, with a focus on difficulties in transitioning individuals with SB. Additionally, we explore new problems that arise during the period of transition related to sexual function and dysfunction. We also discuss some of the difficulties managing neurogenic bladder and the sequalae of their prior urologic surgeries. STUDY DESIGN Each of the authors was asked to provide a summary, based on current literature, to highlight the challenges faced in their area of expertise. CONCLUSIONS Transitioning care for individuals with SB is especially challenging due to associated neurocognitive deficits and neuropsychological functioning issues. Sexual function is an important component of transition that must be addressed in young adults with SB. Management of neurogenic bladder in adults with SB can be challenging due to the heterogeneity of the population and the sequelae of their prior urologic surgeries. The aim is to ensure that all individuals with SB receive appropriate, evidence-based care throughout their lifetime.
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Affiliation(s)
- Joshua D Roth
- Department of Urology, Riley Hospital for Children, Indiana University School of Medicine, United States.
| | - Matthew A Miller
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - Joseph O O'Neil
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - John S Wiener
- Division of Urology, Duke University School of Medicine, United States
| | - Hadley M Wood
- Department of Urology, Cleveland Clinic, United States
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3
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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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O'Kelly F, t'Hoen LA, Burgu B, Banuelos Marco B, Lammers RJM, Sforza S, Hiess M, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Haid B, Radmayr C, Silay MS. A cross-sectional analysis of paediatric urologists' current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care. J Pediatr Urol 2023:S1477-5131(23)00152-3. [PMID: 37173199 DOI: 10.1016/j.jpurol.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. METHODS An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. CONCLUSION This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - B Banuelos Marco
- Department of Urology, University Hospital Clinico San Carlos, Madrid, Spain
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - M Hiess
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - E Bindi
- AOU Delle Marche, Ospedale Pediatrico G Salesi, Department of Pediatric Surgery, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - C Radmayr
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - M S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
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5
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Chawla A, Patil MC, Reddy SJ, Pillai S, N SSB. Global Differences in Management of Neurogenic Bladder: Indian Perspective. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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6
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Fan YH, Shen YC, Hsu CC, Chow PM, Chang PC, Lin YH, Chang SJ, Jiang YH, Liao CH, Wang CC, Wu CT, Kuo HC. Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury. J Clin Med 2023; 12:jcm12041400. [PMID: 36835937 PMCID: PMC9963408 DOI: 10.3390/jcm12041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to present a comprehensive literature review of the efforts of a spinal cord injury workgroup in Taiwan regarding urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. Surgeries can be grouped according to their purpose: reducing bladder pressures, reducing urethra resistance, increasing urethra resistance, and urinary diversion. The choice of surgery depends on the type of LUTD based on urodynamic tests. Additionally, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications should be considered.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Yuan-Chi Shen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Chen Hsu
- Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei 24233, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yu-Hua Lin
- Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 23702, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117)
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7
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Bladder Management Strategies for Urological Complications in Patients with Chronic Spinal Cord Injury. J Clin Med 2022; 11:jcm11226850. [PMID: 36431327 PMCID: PMC9697498 DOI: 10.3390/jcm11226850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients' quality of life, achieving compatibility with patients' lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge.
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8
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Elagami H, Abbas TO, Evans K, Murphy F. Management of neuropathic bladder secondary to spina bifida: Twenty years' experience with a conservative approach. Front Pediatr 2022; 10:913078. [PMID: 35967567 PMCID: PMC9372397 DOI: 10.3389/fped.2022.913078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Treatment of neuropathic bladder secondary to spina bifida is an ongoing challenge. Although different management strategies and protocols are available in the literature, reliance on expert opinion remains fundamental. A conservative approach can be utilized, but patients must be closely monitored throughout the management process. The objective of this study was to review the management and outcomes of neuropathic bladder in spina bifida by appraising long-term bladder and renal function in patients treated at a medical center utilizing a conservative management style. METHODS This is a single-center retrospective review of urology care for all spina bifida patients 5-19 years of age with a neuropathic bladder who attended follow-ups between April 2000 and April 2020. Only patients with more than 5 years of follow-up were included. Renal functions, continence and results of invasive video urodynamics (IUD) and any surgical interventions were recorded. RESULTS Seventy-one patients (mean age = 10.5 years) were identified after exclusions. Bladder compliance between first and last IUDs increased significantly (p = 0.0056). Anticholinergic treatment was started at the first outpatient appointment. Intravesical botulinum toxin injection was the second line treatment in ten patients. 94% of patients had an end fill pressure below 40 cm H2O in their last IUD. 82% were socially continent (dry or occasional damp patches) with or without catheterisations at the age of 11.5 years. One patient in the cohort had bladder augmentation. CONCLUSION The optimal management of neuropathic bladder secondary to spina bifida remains controversial. Bladder and renal functional outcomes can be improved with close monitoring and less invasive management.
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Affiliation(s)
| | - Tariq O Abbas
- Weill Cornell Medicine - Qatar, Ar-Rayyan, Qatar.,Sidra Medicine, Doha, Qatar
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Kondo F, Matsumoto F, Suenaga S, Matsui F, Yazawa K, Nagahara A, Nishimura K, Ishizuya Y. Bladder Cancer in a Long-term Survivor of the Prune Belly Syndrome. Urology 2021; 161:93-95. [PMID: 34883158 DOI: 10.1016/j.urology.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
Abstract
Prune belly syndrome (PBS) is a rare but morbid complexity of congenital anomalies that consists of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. With the recent advances in perinatal care, the life expectancy of patients with PBS has improved. Although renal and sexual outcomes are frequently discussed in the literature, little is known about urinary tract malignancies in adulthood. Herein, we present a case of advanced bladder cancer in a 38-year-old man with PBS. To the best of our knowledge, a malignant tumor arising in a nondefunctionalized or nonaugmented bladder in patients with PBS has not been reported previously.
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Affiliation(s)
- Fuki Kondo
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Fumi Matsumoto
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan.
| | - Shinta Suenaga
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Futoshi Matsui
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Koji Yazawa
- Department of Urology, Osaka Woman's and Children's Hospital, Osaka, Japan
| | - Akira Nagahara
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yu Ishizuya
- Department of Urology, Higashiosaka City Medical Center, Osaka, Japan
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10
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Taghavi K, O'Hagan LA, Bortagaray J, Bouty A, M Hutson J, O'Brien M. Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20-year review. ANZ J Surg 2021; 91:1005-1010. [PMID: 33844426 DOI: 10.1111/ans.16736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. METHODS Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999-2019). Short- and long-term outcomes and complications following augmentation cystoplasty were defined. RESULTS Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy-epispadias complex (30%) and posterior urethral valves (23%). The most common tissue-type utilized was ileal (58%) and ureteric (30%). Peri-operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end-of-study detrusor pressure improved significantly following bladder augmentation (38-17 cmH2 O, P < 0.001). Bladder capacity improved significantly (67-89%, P = 0.041). The median follow-up was 4.5 years (interquartile range: 1.9-10 years). Bladder urolithiasis affected 13 (18%) patients, and symptomatic urinary tract infections 36 (51%) patients. Formation of a continent catheterisable channel contributed a number of complications relating predominantly to stenosis (50%). Repeat augmentation cystoplasty was necessary in three (4%) cases. CONCLUSION Augmentation cystoplasty is a surgical intervention that improves bladder metrics. Given the potential complications, careful patient selection and appropriate pre-operative counselling are essential. Furthermore, pro-active post-operative management and transitional care are vital in the surgical care of children following augmentation cystoplasty.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lomani A O'Hagan
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Juan Bortagaray
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Aurore Bouty
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John M Hutson
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Mike O'Brien
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
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11
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Nip L, Salmo E, Surange R, Calleary J. Mixed histology bladder cancer as a complication of clam ileocystoplasty. BMJ Case Rep 2021; 14:14/1/e238818. [PMID: 33509879 PMCID: PMC7845682 DOI: 10.1136/bcr-2020-238818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department for the investigation of haematuria. CT urogram showed a large left-sided soft tissue mass arising from the bladder. Histological analysis of the shavings from transurethral resection revealed a G3pT2 transitional cell carcinoma and T4N1Mx adenocarcinoma. The patient was referred to oncology for the discussion of palliative chemotherapy; however, in the interim she deteriorated and was admitted to hospital with a post-renal acute kidney injury. A right-sided nephrostomy was inserted relieving her obstruction and she subsequently made a good recovery. This case report illustrates the difficulties in the long-term follow-up of patients having undergone what is now a rarely performed procedure. In the absence of regular cystoscopic follow-up post ileocystoplasty, malignancy may present late and with complications from advanced disease.
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Affiliation(s)
- Lawrence Nip
- Department of Urology, Northern Care Alliance NHS Group, Manchester, UK
| | - Emil Salmo
- Department of Histopathology, Northern Care Alliance NHS Group, Oldham, UK
| | - Raveendra Surange
- Department of Urology, Northern Care Alliance NHS Group, Manchester, UK
| | - John Calleary
- Department of Urology, Northern Care Alliance NHS Group, Manchester, UK
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Soma T, Yokoyama M, Uchida Y, Kirimura S, Tanaka H, Yoshida S, Matsuoka Y, Fujii Y. Long-term survival after radical cystectomy and mesenteric lymph node dissection for squamous cell carcinoma arising from augmented bladder with lymph node metastasis: a case report. Int Cancer Conf J 2021; 10:20-23. [PMID: 33489696 PMCID: PMC7797405 DOI: 10.1007/s13691-020-00442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
Surgical resection is commonly performed for augmented bladder cancer, yet an optimal treatment strategy for augmented bladder cancer with lymph node metastasis has not been established. Here, we report a case that achieved 7 years of survival after radical cystectomy and mesenteric lymph node dissection for squamous cell carcinoma arising from augmented bladder with lymph node metastasis. Extended surgery could be a useful treatment option for locally advanced augmented bladder cancer including mesenteric lymph node metastasis.
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Affiliation(s)
- Takahiko Soma
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Yusuke Uchida
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Susumu Kirimura
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
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The Current Positioning of Augmentation Enterocystoplasty in the Treatment for Neurogenic Bladder. Int Neurourol J 2020; 24:200-210. [PMID: 33017891 PMCID: PMC7538291 DOI: 10.5213/inj.2040120.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/14/2020] [Indexed: 11/13/2022] Open
Abstract
Augmentation enterocystoplasty (AEC) is a surgical procedure in which the bladder is enlarged using an intestinal segment in patients with lower urinary tract dysfunction who fail to achieve satisfactory results with all conservative treatments. Currently, surgical materials and procedures, concomitant correction of upper urinary tract abnormalities, or bladder neck reconstruction may vary depending on the experience and preferences of the surgeons. AEC has been proven to be successful with respect to surgical goals, such as achieving urinary continence, improving quality of life, and preserving the upper urinary tract over the long term. The advantage of AEC over intravesical injection of botulinum toxin—a more recent and less invasive procedure—is that the prevention of upper urinary tract damage and the improvement of urinary incontinence are more reliably guaranteed, especially considering that these surgical effects are permanent. Compared to less invasive treatments, the quality of life of patients after surgery is also much higher, and AEC may be more cost-effective in the long run. Thus, in patients with neurogenic bladder, AEC is still the gold standard surgical procedure with strong evidence in support of its efficacy. In this article, the indications, surgical methods, possible complications, long-term follow-up, and current positioning of AEC in lower urinary tract dysfunction is discussed.
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Le HK, Cardona-Grau D, Chiang G. Evaluation and Long-term Management of Neurogenic Bladder in Spinal Dysraphism. Neoreviews 2020; 20:e711-e724. [PMID: 31792158 DOI: 10.1542/neo.20-12-e711] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Spinal dysraphism, which includes conditions such as myelomeningocele and sacral agenesis, is one of the most common causes of congenital lower urinary tract dysfunction. Early evaluation of the neurogenic bladder serves to minimize renal damage, and the main goals of management include preserving renal function, achieving acceptable continence, and optimizing quality of life. The survival of patients with such conditions has improved to greater than 80% reaching adulthood, owing to advances in diagnostic and therapeutic modalities. The result is a real, and unfortunately often unmet, need for successful transitional care in this complex patient population. Clinicians must be able to identify the unique challenges encountered by patients with neurogenic bladder as they shift through different stages of their life.
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Affiliation(s)
- Hoang-Kim Le
- Division of Pediatric Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | | | - George Chiang
- Division of Pediatric Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
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15
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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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16
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Bladder cancer in patients with spina bifida: a serious risk. World J Urol 2020; 39:1531-1537. [PMID: 32632554 DOI: 10.1007/s00345-020-03338-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE After bladder augmentation (BA) using bowel segments, it is known that there is a risk for secondary malignancies. It remains unclear whether this also applies to spina bifida (SB) patients without BA. The aim of this study was to analyze the frequency of bladder cancer (BC) in SB at a single tertiary institution and assess the patients' oncologic outcome. METHODS Patients with SB and BC treated from January 2016 until March 2020 were included and corresponding data were collected retrospectively. Endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS Among 132 adult patients with SB, four with a median age of 34.5 years (IQR 31.5-36.8, range 31-37) had a BC. None of the patients had undergone BA. Most common symptoms included recurrent urinary tract infections (UTI) (75%) and hydronephrosis (75%). At the time of the diagnosis, tumors were locally advanced (≥ T3) and lymph-node positive in all cases. All patients underwent radical cystectomy with adjuvant chemotherapy in two out of four cases. Histology showed squamous cell carcinomas (SCC) or at least a squamous cell component in all patients. The median PFS was 5.9 months (IQR 5.1-124.5) and the median OS was 8.7 months (IQR 6.3-125.5). CONCLUSIONS SCC in SB can appear at a young age and is usually diagnosed in an advanced tumor stage with poor prognosis despite radical surgical resection. Patients with SB without BA with clinical symptoms, new onset of hematuria, and/or upper tract dilatation should receive a cystoscopy ± further imaging.
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17
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Complications of Pediatric Bladder Reconstruction in the Adult Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Wiener JS, Huck N, Blais AS, Rickard M, Lorenzo A, Di Carlo HNM, Mueller MG, Stein R. Challenges in pediatric urologic practice: a lifelong view. World J Urol 2020; 39:981-991. [PMID: 32328778 DOI: 10.1007/s00345-020-03203-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
The role of the pediatric urologic surgeon does not end with initial reconstructive surgery. Many of the congenital anomalies encountered require multiple staged operations while others may not involve further surgery but require a life-long follow-up and often revisions. Management of most of these disorders must extend into and through adolescence before transitioning these patients to adult colleagues. The primary goal of management of all congenital uropathies is protection and/or reversal of renal insult. For posterior urethral valves, in particular, avoidance of end-stage renal failure may not be possible in severe cases due to the congenital nephropathy but usually can be prolonged. Likewise, prevention or minimization of urinary tract infections is important for overall health and eventual renal function. Attainment of urinary continence is an important goal for most with a proven positive impact on quality of life; however, measures to achieve that goal can require significant efforts for those with neuropathic bladder dysfunction, obstructive uropathies, and bladder exstrophy. A particular challenge is maximizing future self-esteem, sexual function, and reproductive potential for those with genital anomalies such as hypospadias, the bladder exstrophy epispadias complex, prune belly syndrome, and Mullerian anomalies. Few endeavors are rewarding as working with children and their families throughout childhood and adolescence to help them attain these goals, and modern advances have enhanced our ability to get them to adulthood in better physical and mental health than ever before.
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Affiliation(s)
- John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Nina Huck
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne-Sophie Blais
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, ON, Canada
| | - Armando Lorenzo
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Heather N McCaffrey Di Carlo
- The James Buchanan Brady Urologic Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Margaret G Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics & Gynecology and Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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19
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Joseph DB, Baum MA, Tanaka ST, Frimberger DC, Misseri R, Khavari R, Baillie S, Yerkes EB, Wood H. Urologic guidelines for the care and management of people with spina bifida. J Pediatr Rehabil Med 2020; 13:479-489. [PMID: 33252091 PMCID: PMC7838970 DOI: 10.3233/prm-200712] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The life expectancy for people with spina bifida has increased, thus resulting in greater need for guidelines in urologic care in order to protect normal renal function, to develop strategies for urinary continence, and to advance independence through adult years. METHODS The English literature was assessed from 2002-2015; greater than 300 publications identified. Case reports and opinion pieces were eliminated leaving 100 for in depth review. Clinical questions were then established for each age group that allowed for focused assessment. RESULTS There was no Level 1 evidence for any of the defined clinical questions. This resulted in group consensus for all questions throughout all age groups. Guidelines were provided for identifying a symptomatic urinary infection, the role of urodynamic bladder testing and identification of bladder hostility, determining methods of renal function assessment and surveillance, the initiation of continence control, and transitioning to self-care through the teen and adult years. CONCLUSION Urologic guidelines continue to be based on clinical consensus due to the lack of high level evidence-based research. Further research is required in all aspects of urologic management. While not the "Standard of Care," these guidelines should be considered "Best Practice".
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Affiliation(s)
- David B Joseph
- University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama, USA
| | - Michelle A Baum
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy T Tanaka
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dominic C Frimberger
- Children's Hospital of Oklahoma, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Rosalia Misseri
- Indiana University School of Medicine, Riley Children's Health, Indianapolis, Indiana, USA
| | | | | | - Elizabeth B Yerkes
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hadley Wood
- Cleveland Clinic, Glickman Urologic and Kidney Institute, Cleveland, Ohio, USA
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20
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Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management. Neurourol Urodyn 2019; 39:498-506. [PMID: 31794087 DOI: 10.1002/nau.24248] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/16/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimes-even in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. MATERIAL & METHODS After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. CONCLUSION In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan S Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, First Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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21
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Kardos DJ, Kereskai L, Tornoczky T, Farkas K, Davidovics A, Farkas A, Vastyan AM, Pinter AB, Vajda P. Re-evaluation of histological findings after colocystoplasty and gastrocystoplasty. J Pediatr Urol 2019; 15:651.e1-651.e8. [PMID: 31735521 DOI: 10.1016/j.jpurol.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The potential of malignant transformation and its risk factors after bladder augmentation performed in childhood are still unknown. The necessity of surveillance cystoscopies and biopsies has been questioned in the past decade. OBJECTIVE In a previous study, the authors did not detect any malignancy after colocystoplasty (CCP) or gastrocystoplasty (GCP) during the short-term follow-up, however, various alterations of the mucosa were found. A correlation between the nature of histological changes and the frequency of bacterial colonization after CCP were also found. The authors hypothesized that a longer-term follow-up of their patients would reveal an increase in pathological change or show stronger association between the histological alteration, bacterial colonization, and/or stone formation. PATIENTS AND METHODS Thirty-five patients (20 cases of colocystoplasties - CCPs; 15 cases of gastrocystoplasties - GCPs) participated in the study published in 2002. All patients were followed biannually with endoscopic assessment and biopsies. Two independent pathologists, evaluated regular biopsies from the native bladder, from the segment used for augmentation and from the anastomosis line. Etiology, frequency of positive urine cultures, and stone events were recorded and compared with histological findings between groups and with the previously published results. RESULTS Continuous surveillance allowed the follow-up of 30 patients (CCP 19/20, GCP 11/15) for 20 and 15 years. No malignancies were identified. Results of biopsies showed significant difference between groups (summarized in the tables). Chronic inflammatory changes were found following both types of augmentations, but they were more common in the urothelium following GCP and more common in the colonic mucosa following CCP. The rate of metaplastic lesions was higher after gastrocystoplasty (GCP). Significant association was found between the etiologic factor and the nature of histological change after CCP, as metaplastic lesions occurred only in patients with bladder exstrophy. Stones occurred more frequently in exstrophy patients as well. The nature of the histological changes did not correlate with positive urine cultures in either of the groups. Significantly higher incidence of bacterial colonization and stone occurrence were found after CCP. CONCLUSIONS Long-term follow-up of the patients failed to reveal an increase in pathological changes, and no malignancies were observed. According to the results of this study, etiology of bladder dysfunction and the type of augmentation might influence the histological alterations after augmentation cystoplasty. The efficiency of surveillance cystoscopies and biopsies are low. The present data suggest that surveillance cystoscopy and biopsy should not be routinely performed, and should be done only if the symptoms are suspicious for malignancy.
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Affiliation(s)
- Daniel J Kardos
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Laszlo Kereskai
- Department of Pathology, University of Pecs, Medical School, Hungary
| | - Tamas Tornoczky
- Department of Pathology, University of Pecs, Medical School, Hungary
| | - Kornelia Farkas
- Institute of Bioanalysis, University of Pecs, Medical School, Hungary
| | - Anna Davidovics
- Department of Languages for Specific Purposes, University of Pecs, Medical School, Hungary
| | - Andrew Farkas
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Attila M Vastyan
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Andrew B Pinter
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
| | - Peter Vajda
- Department of Paediatrics, Division of Paediatric Surgery, University of Pecs, Medical School, Hungary
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22
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Cheng PJ, Myers JB. Augmentation cystoplasty in the patient with neurogenic bladder. World J Urol 2019; 38:3035-3046. [PMID: 31511969 DOI: 10.1007/s00345-019-02919-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To review the indications and techniques of augmentation cystoplasty (AC) in patients with neurogenic bladder (NGB) while also examining the long-term outcomes, complications, and follow-up surgeries. METHODS PubMed/MEDLINE, Cochrane Library, and Embase databases were searched for articles related to AC and NGB. RESULTS AC is indicated for an overactive or poorly compliant bladder refractory to conservative therapies, such as anticholinergic medications and bladder botulinum toxin injections. A variety of surgical techniques using gastrointestinal segments, alternative tissues, and synthetic materials have been described, though bowel remains the most durable. Ileocystoplasty is the most common type of AC, which uses a detubularized patch of ileum that is anastomosed to a bivalved bladder. Some patients undergo concomitant surgeries at the time of AC, such as catheterizable channel creation to aid with clean intermittent catheterization, ureteral reimplantation to treat vesicoureteral reflux, and bladder outlet procedure to treat incontinence. Following AC, the majority of patients experience an improvement in bladder capacity, compliance, and continence. Most patients also experience an improvement in quality of life. AC has significant complications, such as chronic UTIs, bladder and renal calculi, metabolic disturbances, bowel problems, perforation, and malignancy. AC also has a high rate of follow-up surgeries, especially if the patient undergoes concomitant creation of a catheterizable channel. CONCLUSIONS Enterocystoplasty remains the gold standard for AC, though more research is needed to better evaluate the morbidity of different surgical techniques and the indications for concomitant surgeries. Experimental methods of AC with tissue engineering are a promising area for further investigation.
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Affiliation(s)
- Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
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Bouhout S, Chabaud S, Bolduc S. Collagen hollow structure for bladder tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 102:228-237. [DOI: 10.1016/j.msec.2019.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/13/2019] [Accepted: 04/16/2019] [Indexed: 01/03/2023]
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Budzyn J, Trinh H, Raffee S, Atiemo H. Bladder Augmentation (Enterocystoplasty): the Current State of a Historic Operation. Curr Urol Rep 2019; 20:50. [PMID: 31342172 DOI: 10.1007/s11934-019-0919-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to evaluate the current use of enterocystoplasty, a historical operation for bladder dysfunction but with continued and increasing modern relevance. RECENT FINDINGS Since the advent of third line neuromodulation techniques for neurogenic and idiopathic overactive bladder (OAB), the usage of enterocystoplasty has decreased. However, this procedure continues to be utilized in pediatric urology patients and the most refractory OAB patients. Adult urologist should be familiar with this operative technique in an effort to manage pediatric patients transitioning to adulthood. Minimally invasive techniques for this surgical procedure have been described with very limited outcome data. It is important for all urologists to be familiar with enterocystoplasty, both technically and with the unique needs of these patients postoperatively. Further studies evaluating the outcomes of this procedure in idiopathic overactive bladder patients and efforts to standardize recommendations for neurogenic bladder patients will help guide care in the future.
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Affiliation(s)
- Jeffrey Budzyn
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Hamilton Trinh
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Samantha Raffee
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Humphrey Atiemo
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA.
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25
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Outcomes of Bladder Preservation Following Treatment for Rhabdomyosarcoma. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stein R, Zahn K, Huck N. Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction. Front Pediatr 2019; 7:236. [PMID: 31245339 PMCID: PMC6581750 DOI: 10.3389/fped.2019.00236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/28/2023] Open
Abstract
Today, there are few indications for the use of bowel in pediatric urology. This is in large extent due to the successful conservative therapy in patients with neurogenic bladder and the improved success of primary reconstruction in patients with the bladder exstrophy-epispadias complex. Only after the failure of the maximum of conservative therapy or after failure of primary reconstruction, bladder augmentation, or urinary diversion should be considered. Malignant tumors of the lower urinary tract (e.g., rhabdomyosarcomas of the bladder/prostate) are other rare indications for urinary diversion. Replacement or reconstruction of the ureter with a bowel segment is also a quite rarely performed procedure. In this review, the advantages and disadvantages of the different options for the use of bowel segments for bladder augmentation, bladder substitution, urinary diversion, or ureter replacement during childhood and adolescence are discussed.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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27
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Executive summary. Can Urol Assoc J 2019; 13:156-165. [PMID: 31199234 DOI: 10.5489/cuaj.6041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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Cooley LF, Kielb S. A Review of Botulinum Toxin A for the Treatment of Neurogenic Bladder. PM R 2019; 11:192-200. [PMID: 30138720 DOI: 10.1016/j.pmrj.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/28/2018] [Indexed: 01/23/2023]
Abstract
Prior to FDA approval of intradetrusor botulinum toxin (BoTA) injections for the treatment of neurogenic bladder, patients' treatment options were limited to use of pharmacotherapies such as antimuscarinics, alpha blockers, and more recently beta agonists (some off-label) or invasive interventions including bladder augmentation and urinary diversion procedures. Herein, we provide a comprehensive literature review detailing the salient clinical literature that led to FDA approval of intradetrusor BoTA for neurogenic bladder. Patients with neurogenic detrusor overactivity and detrusor sphincter dyssynergia have been shown in randomized studies to benefit significantly from intradetrusor BoTA injection with regard to the following parameters: improved voided volume, improved bladder pressure and urodynamic parameters, reduced incidence of urinary tract infection, and improved quality of life. Intradetrusor BoTA injection has revolutionized the treatment landscape for patients with neurogenic bladder by providing them with a safe, efficacious, and cost-effective means to reduce bladder dysfunction, preserve renal function, and reduce the need for invasive, surgical intervention. LEVEL OF EVIDENCE: I.
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Affiliation(s)
- Lauren Folgosa Cooley
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Tarry 16-703 Chicago, Illinois 60611
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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Nayak A, Depasquale B, Vergara N, Guzzo TA, Lal P. Villous Adenoma Arising in the Native Bladder Mucosa and the Upper Urinary Tract With Coexisting Neuroendocrine Carcinoma Following Augmentation Cystoplasty. Int J Surg Pathol 2019; 27:450-456. [PMID: 30701999 DOI: 10.1177/1066896919826708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Villous adenomas arising in the bladder following augmentation cystoplasty procedures are exceedingly rare. Even rarer is their occurrence in the native bladder mucosa and the upper urinary tract. In this article, we present a unique case of multifocal recurrent villous adenoma involving native bladder mucosa of an augmented bladder, bilateral ureters, and renal pelvis, with coexistent foci of adenocarcinoma and neuroendocrine carcinoma, in a patient with history of augmentation colocystoplasty. We additionally discuss the pathogenesis of development of carcinoma in the setting of augmentation cystoplasty.
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Affiliation(s)
- Anupma Nayak
- 1 University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Priti Lal
- 1 University of Pennsylvania, Philadelphia, PA, USA
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Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center. Int Neurourol J 2019; 22:287-294. [PMID: 30599500 PMCID: PMC6312970 DOI: 10.5213/inj.1836174.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/18/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. METHODS A retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables. RESULTS Renal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected. CONCLUSION We consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.
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Pina IM, Omar AM, Khadr RN, Floyd MS. Re: Transition to adulthood with a bladder augmentation: histopathologic concerns. Int Braz J Urol 2018; 44:850-851. [PMID: 29757576 PMCID: PMC6092650 DOI: 10.1590/s1677-5538.ibju.2018.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ines Mendes Pina
- Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, Whiston Hospital, Liverpool, United Kingdom, UK
| | - Ahmed M Omar
- Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, Whiston Hospital, Liverpool, United Kingdom, UK
| | - Rauf N Khadr
- Northwest Regional Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, Town Lane, Kew, Merseyside, United Kingdom, UK
| | - Michael S Floyd
- Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, Whiston Hospital, Liverpool, United Kingdom, UK.,Northwest Regional Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, Town Lane, Kew, Merseyside, United Kingdom, UK
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Metcalfe P, De S, Bailly G. Augmented bladders and urinary diversions. Can Urol Assoc J 2018; 12:S24-S26. [PMID: 29681270 DOI: 10.5489/cuaj.5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Shuba De
- University of Alberta, Edmonton, AB
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Affiliation(s)
- Alvaro A Saavedra
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
| | - Dawn Maclellan
- Department of Urology, Dalhousie University, Halifax, NS; Canada
| | - Gary J Gray
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
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35
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Aikawa A, Muramatsu M, Takahashi Y, Hamasaki Y, Hashimoto J, Kubota M, Hyoudou Y, Itabashi Y, Kawamura T, Shishido S. Surgical Challenge in Pediatric Kidney Transplant: Lower Urinary Tract Abnormality. EXP CLIN TRANSPLANT 2018. [PMID: 29527985 DOI: 10.6002/ect.tond-tdtd2017.l42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lower urinary tract abnormalities are difficult to resolve in pediatric kidney transplant patients. Measure of residual urine, voiding cystourethrography, retrograde urethrography, cystometry, electromyography of urethral external sphincter muscle, urethrometry, and uroflowmetry are the primary methods for evaluation of lower urinary tract abnormalities. Endoscopic resection or ablation of urethral valves is required in children with posterior urethral valve to treat obstruction, but bladder function does not always recover and may deteriorate to end-stage renal failure even after the obstruction is released. This bladder dysfunction in posterior urethral valve defines valve bladder syndrome. Vesicoureteral reflux caused by high vesical pressure can cause even worse renal graft function posttransplant. In our patient group, urinary diversion occurred with Mitrofanoff conduit using an appendix in 6 children, a Yang-Monti channel conduit using ileum in 1 patient, with cystostomy in 3 children, and with augmented cystoplasty in 9 children before or simultaneously with kidney transplant. These procedures should be selected based on the type of lower urinary tract abnormality including bladder function. Recently, we have preferred a continent diversion for self-catheterization in children with lower urinary tract abnormalities. We have conducted 9 augmented cystoplasty procedures using a portion of the sigmoid colon or ileum. Seventeen children retained their own bladders when the transplant ureter was implanted. Most patients needed clean intermittent catheterization, depending on the residual urine volume and a bladder function. Ten-year graft survival rate in kidney transplant in our department is 98% in 36 children with lower urinary tract abnormalities. Lower urinary tract abnormality is not always a risk factor for pediatric kidney transplant; however, a preoperative evaluation is important to choose the best option for urinary diversion.
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Affiliation(s)
- Atsushi Aikawa
- From the Department of Nephrology, Toho University, Toho, Japan
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36
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Wu SY, Kuo HC. A real-world experience with augmentation enterocystoplasty-High patient satisfaction with high complication rates. Neurourol Urodyn 2018; 37:744-750. [DOI: 10.1002/nau.23339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/26/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Shu-Yu Wu
- Department of Urology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
| | - Hann-Chorng Kuo
- Department of Urology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
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A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. Actas Urol Esp 2018; 42:5-16. [PMID: 28413135 DOI: 10.1016/j.acuro.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.
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Borau A, Adot J, Allué M, Arlandis S, Castro D, Esteban M, Salinas J. A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.acuroe.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Singh P, Bansal A, Sekhon V, Nunia S, Ansari MS. Can baseline serum creatinine and e-GFR predict renal function outcome after augmentation cystoplasty in children? Int Braz J Urol 2018; 44:156-162. [PMID: 28727382 PMCID: PMC5815546 DOI: 10.1590/s1677-5538.ibju.2017.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess cut-off value of creatinine and glomerular filtration rate for augmentation cystoplasty (AC) in paediatric age-group. MATERIALS AND METHODS Data of all paediatric-patients (<18 years) with small capacity bladder, in whom AC was advised between 2005-2015 were reviewed. All patients were divided in two-groups, AC-group and control-group (without AC). Creatinine and e-GFR were assessed at the time of surgery, at 6 months and at last follow-up. Renal function deterioration was defined as increase in creatinine by ≥25% from baseline value or new-onset stage-3 CKD or worsening of CKD stage with pre-operative-CKD stage-3. ROCs were plotted using creatinine and e-GFR for AC. RESULTS A total of 94 patients with mean-age 8.9 years were included. The mean creatinine and e-GFR were 1.33mg/dL and 57.68mL/min respectively. Out of 94 patients, AC was performed in 45 patients and in the remaining 49 patients AC was not done (control-group), as they were not willing for the same. Baseline patient's characteristics were comparable in both Groups. 22 underwent gastro-cystoplasty (GC) and 25 underwent ileo-cystoplasty (IC). Decline in renal function was observed in 15 (33.3%) patients of AC-group and in 31 (63.3%) patients of control-group. Patients having creatinine ≥1.54mg/dL (P=0.004, sensitivity (S) 63.6% and specificity (s) 90.5%) at baseline and e-GFR ≤46mL/min (P=0.000, S=100% and s=85.7%) at the time of surgery had significantly increased probability of renal function deterioration on follow-up after AC. CONCLUSION e-GFR ≤46mL/min and creatinine ≥1.54mg/dL at time of surgery could serve as a predictor of renal function deterioration in AC in paediatric patients.
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Affiliation(s)
- Prempal Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ankur Bansal
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Virender Sekhon
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Nunia
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M. S. Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Islam MM, Saltzman AF, Carrasco A, Higuchi T. Incidental Discovery of Adenocarcinoma of an Augmented Bladder in a Patient With Myelomenigocele Undergoing Cystolithotomy. Urology 2017; 113:203-205. [PMID: 29196068 DOI: 10.1016/j.urology.2017.11.027] [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: 08/05/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/30/2022]
Abstract
Bladder malignancy in patients with congenital bladder anomalies who have undergone bladder augmentation is a rare but well-recognized condition. These patients present with locally advanced or metastatic disease and have poor survival. We report a case of a patient with myelomeningocele who was incidentally found to have a high-grade intestinal type adenocarcinoma of her bladder augment at the time of cystolithotomy. This case highlights the need to continue to follow patients with congenital bladder anomalies and highlights the lack of adequate screening methods available.
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Affiliation(s)
- Majdee M Islam
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
| | - Amanda F Saltzman
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO.
| | - Alonso Carrasco
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
| | - Ty Higuchi
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
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Sui X, Lei L, Chen L, Xie T, Li X. Inflammatory microenvironment in the initiation and progression of bladder cancer. Oncotarget 2017; 8:93279-93294. [PMID: 29190997 PMCID: PMC5696263 DOI: 10.18632/oncotarget.21565] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/08/2017] [Indexed: 12/18/2022] Open
Abstract
Accumulating evidence suggests the idea that chronic inflammation may play a critical role in various malignancies including bladder cancer and long-term treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is significantly effective in reducing certain cancer incidence and mortality. However, the molecular mechanisms leading to malignant transformation and the progression of bladder cancer in a chronically inflammatory environment remain largely unknown. In this review, we will describe the role of inflammation in the formation and development of bladder cancer and summarize the possible molecular mechanisms by which chronic inflammation regulates cell immune response, proliferation and metastasis. Understanding the novel function orchestrating inflammation and bladder cancer will hopefully provide us insights into their future clinical significance in preventing bladder carcinogenesis and progression.
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Affiliation(s)
- Xinbing Sui
- Department of Medical Oncology Holistic Integrative Oncology Institutes and Holistic Integrative Pharmacy Institutes, The Affiliated Hospital of Hangzhou Normal University, College of Medicine, Hangzhou Normal University, Hangzhou, China.,Department of Medical Oncology Holistic Integrative Cancer Center of Traditional Chinese and Western Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Liming Lei
- Department of Cardiovascular Surgery of Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Liuxi Chen
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tian Xie
- Department of Medical Oncology Holistic Integrative Oncology Institutes and Holistic Integrative Pharmacy Institutes, The Affiliated Hospital of Hangzhou Normal University, College of Medicine, Hangzhou Normal University, Hangzhou, China.,Department of Medical Oncology Holistic Integrative Cancer Center of Traditional Chinese and Western Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xue Li
- Departments of Urology and Pathology, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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Even L, Mouttalib S, Moscovici J, Soulie M, Rischmann P, Game X, Galinier P, Bouali O. De l’urologie pédiatrique à l’urologie adulte, quelle prise en charge de l’adolescent ? État des lieux d’une consultation de transition en urologie. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Systematic review of bladder cancer outcomes in patients with spina bifida. J Pediatr Urol 2017; 13:456.e1-456.e9. [PMID: 28687411 DOI: 10.1016/j.jpurol.2017.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with congenital bladder anomalies, bladder augmentation is used as a last resort to reduce intravesical pressure, but concerns about malignant transformation in augmented patients were first raised in the 1980s. The best evidence to date indicates that augmentation does not appear to increase the risk of bladder cancer in spina bifida patients. To date, oncologic outcomes from patients with spina bifida with and without augmentation have only been available in small case reports. OBJECTIVE To systematically evaluate factors in myelomeningocele patients with bladder cancer, including bladder augmentation, that contribute to overall survival (OS). STUDY DESIGN A systematic review using PubMed was conducted by cross referencing terms 'myelomeningocele,' 'cystoplasty,' 'bladder cancer' and respective synonyms according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Inclusion criteria were studies with patients with an underlying diagnosis of myelomeningocele and bladder cancer with data on age, stage, and mortality status. Studies were excluded for spinal cord injury, history of tuberculosis or schistosomiasis, or prior ureterosigmoidostomy. RESULTS Fifty-two patients were identified from 28 studies with a median age at bladder cancer diagnosis of 41 years (range 13-73); 37 (71%) presented with stage III or IV bladder cancer. Overall survival at 1 year and 2 years was 48.5% and 31.5%, respectively. Overall survival was different between those with and without augmentation (P = 0.009) by log-rank analysis. No between-group differences in OS were seen based on age, management with indwelling catheter, diversion with ileal conduit or being on a surveillance program. Only stage remained a significant predictor of OS on multivariate analysis (HR 2.011, 95% CI 1.063-3.804, P = 0.032). Secondary analysis was performed after removing patients with gastric augmentation (n = 8), and no difference in OS was seen between patients with (n = 8) and without augmentation (n = 36, P = 0.112). Of augmented patients, latency to development of bladder cancer was variable (Summary Figure). DISCUSSION Bladder cancer is a deadly diagnosis in patients with congenital bladder anomalies like spina bifida, and while overall prevalence of the two conditions occurring together is low, bladder cancer will go on to affect 2-4% of spina bifida patients. The present study examined overall survival, and further characterized outcomes in these patients. Presence of a bladder augment did not appear to worsen overall survival. CONCLUSIONS Patients with myelomeningocele who developed bladder cancer had aggressive disease. Augmentation did not worsen OS, based on cases reported in the literature. Risk of bladder cancer should be discussed with all myelomeningocele patients.
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Husmann DA. Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non-lethal complications of bladder augmentation. Int J Urol 2017; 25:94-101. [DOI: 10.1111/iju.13417] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/11/2017] [Indexed: 12/19/2022]
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Abstract
INTRODUCTION Three complications have been hypothesized to increase patient mortality following enterocystoplasty: spontaneous bladder perforation, bladder neoplasia, and chronic renal failure (CRF). The present study examined risk of their occurrence and discussed ways to improve the quality of care. MATERIALS AND METHODS The present transitional clinic followed 385 patients with a history of bladder augmentation using either ileal, sigmoid, or ascending colon. The median age was 37 years (range 16-71). Median follow-up interval after augmentation was 26 years (range 2-59). DISCUSSION Spontaneous rupture of the bladder occurred in 3% (13/385), with one associated death (0.25%, 1/385). Spontaneous bladder rupture significantly correlated with substance abuse, non-compliance with catheterization, and mental/physical disabilities that required the use of surrogates to perform and monitor intermittent catheterization (P < 0.01). Of the 203 patients that were followed for ≥10 years, 4% (8/203) developed a bladder tumor. In comparison, 2.5% (5/203) of an age-matched control population, managed by anticholinergics and intermittent catheterization, developed a bladder tumor. Therefore, enterocystoplasty cannot be associated with an increased risk of cancer development (P = 0.397). Chronic renal failure ≥ Stage 3 arose in 15% (58/385), and 1% (4/385) of the patients died as a result of this complication. Obese patients (BMI ≥30) catheterizing per urethra were more likely to be non-compliant with catheterization and develop CRF compared with obese patients with a continent catheterizable stoma (P > 0.001). These findings suggest that compliance with intermittent catheterization and renal preservation are enhanced by the presence of a catheterizable abdominal stoma. CONCLUSION The individual's intellectual and physical capability to obey medical directives, refrain from high-risk habits, maintain a healthy weight, and comply with long-term follow-up visits were all critical to the enduring success of bladder augmentation.
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Affiliation(s)
- D A Husmann
- Department of Urology, 200 First St SW, Mayo Clinic, Rochester, MN 55905, USA.
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Santos AMD, Coelho JPF, Juanes CDC, Azevedo RBD, Diniz CA, Jamacaru FVF, Dornelas CA. Transitional metaplasia in intestinal epithelium of rats submitted to intestinal cystoplasty and treatment with L -lysine. Acta Cir Bras 2017; 32:297-306. [PMID: 28538804 DOI: 10.1590/s0102-865020170040000297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/21/2017] [Indexed: 02/01/2023] Open
Abstract
Purpose: To evaluated the effects of L-lysine on the intestinal and urothelial epithelia in cystoplasty in rats. Methods: Twenty-eight 9-week-old rats were assigned to 4 groups: Group A (n=8) cystoplasty followed by administration of L-lysine (150 mg/kg body weight by gavage) for 30 weeks; Group B (n=8) cystoplasty + water for 30 weeks; Group C (n=6) L-lysine for 30 weeks; Group D (n=6) water for 30 weeks. Results: On histopathology with hematoxylin and eosin, mild to moderate hyperplasia transitional was observed in at the site of anastomosis in all animals submitted to cystoplasty (Groups A and B), but "transitional metaplasia" of the intestinal glandular epithelium was more accentuated in Group A (p=0.045). No inflammatory cells, dysplasia or abnormalities were observed. Staining with Alcian blue revealed a substantial reduction of goblet cells and mucins in the colon segment (Groups A and B). Conclusion: The administration of L-lysine to rats accelerated the development of transitional metaplasia in the epithelium of the colon segment in cystoplasty.
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Affiliation(s)
- Alessandra Marques Dos Santos
- Fellow Master degree, Postgraduate Program in Pathology, Department of Pathology, Universidade Federal do Ceará (UFC), Brazil. Intellectual and scientific content of the study, histopathological examinations, technical procedures, manuscript preparation
| | | | | | | | - Clara Araujo Diniz
- Graduate student, Scientific Iniciation Program, UFC, Fortaleza-CE, Brazil. Acquisition of data
| | - Francisco Vagnaldo Fechine Jamacaru
- PhD, Researcher, Núcleo de Pesquisa e Desenvolvimento de Medicamentos (NPDM), School of Medicine, UFC, Fortaleza-CE, Brazil. Analysis and interpretation of data, statistical analysis
| | - Conceição Aparecida Dornelas
- PhD, Associate Professor, Department of Pathology, UFC, Fortaleza-CE, Brazil. Conception and design of the study, technical procedures, critical revision, supervised all phases of the study
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Metcalfe PD. Neuropathic bladders: Investigation and treatment through their lifetime. Can Urol Assoc J 2017; 11:S81-S86. [PMID: 28265327 DOI: 10.5489/cuaj.4276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The child with a neuropathic bladder requires lifelong dedicated care. Just as each patient presents with unique physiology, each phase of their life presents varying challenges. The primary concern for our patients is their renal health, but continence and independence also play significant roles. Most patients can be managed conservatively, but a myriad of surgical options are also available, reinforcing our emphasis on individualized care. Appropriate pre-surgical planning is required to ensure the right patient receives the best operation for his/her wants and needs. Furthermore, the numerous potential complications must be understood and long-term followup and surveillance is required. This review outlines the basic pathophysiology, investigations, and treatments, with a focus on the changing needs throughout their lives.
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Affiliation(s)
- Peter D Metcalfe
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
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Çetinel B, Kocjancic E, Demirdağ Ç. Augmentation cystoplasty in neurogenic bladder. Investig Clin Urol 2016; 57:316-23. [PMID: 27617312 PMCID: PMC5017553 DOI: 10.4111/icu.2016.57.5.316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022] Open
Abstract
The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction.
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Affiliation(s)
- Bülent Çetinel
- Department of Urology, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ervin Kocjancic
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Çetin Demirdağ
- Department of Urology, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Boissier R, Di Crocco E, Faure A, Hery G, Delaporte V, Lechevallier E, Mouriquand PDE, Guys JM, Karsenty G. What is the outcome of paediatric gastrocystoplasty when the patients reach adulthood? BJU Int 2016; 118:980-986. [PMID: 27322857 DOI: 10.1111/bju.13558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To document the long-term outcomes of paediatric augmentation gastrocystoplasty (AGC) in terms of preservation of renal function and maintenance of dryness, and to analyse the rate of complications. PATIENTS AND METHODS The medical records of children who had undergone AGC between 1992 and 2000 (minimum time interval of 15 years) were reviewed retrospectively. The following data were collected: age at surgery, the cause of bladder dysfunction, functioning of the AGC, any complications, and the long-term outcome of the patients. All of the patients were re-contacted by telephone. RESULTS A total of 11 AGCs were carried out between 1992 and 2000, at a median (range) age of 11 (6.5-14) years. The diagnosis of patients undergoing AGC included myelomeningocele (four), bladder exstrophy (four), posterior urethral valves (one), irradiated bladder (one), and Prune Belly syndrome (one). The median [interquartile range (IQR)] follow-up was 17 (15-19.5) years. Renal function was preserved or improved in seven of the 11 patients and nine patients were dry after AGC. Seven of the 11 patients reported symptoms linked to haematuria-dysuria syndrome, which was resistant to treatment in one case and requiring excision of the gastric patch. Three of the 11 patients developed a tumour on the gastric graft after a median (range) delay of 20 (11-22) years after the initial procedure. All had gastric adenocarcinoma of which two were metastatic at the time of diagnosis requiring pelvectomy with pelvic lymph node dissection and adjuvant chemotherapy. Seven of the 11 patients underwent excision of the gastric patch after a median (IQR) time of 11 (8.5-20.5) years. CONCLUSIONS Our long-term data confirmed that most patients undergoing AGC had preservation of their renal function and were continent. However, long-term, AGC was associated with a significant risk of malignant transformation and a high rate of surgical re-intervention involving removal of the gastric patch. These results question the use of this technique for bladder augmentation, irrespective of the indication. We highlight the importance of strict endoscopic follow-up of all patients already having undergone an AGC and the need to inform and educated patients about tumour-related symptoms.
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Affiliation(s)
- Romain Boissier
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Eugenie Di Crocco
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Alice Faure
- Aix-Marseille Université, Marseille, France.,APHM, Service de Chirurgie Pédiatrique, CHU Hôpital Timone, Marseille, France
| | - Geraldine Hery
- Aix-Marseille Université, Marseille, France.,APHM, Service de Chirurgie Pédiatrique, CHU Hôpital Timone, Marseille, France
| | - Véronique Delaporte
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Eric Lechevallier
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
| | - Pierre D E Mouriquand
- Service d'Urologie Pédiatrique, Hospices Civils de Lyon et Université Claude Bernard, Lyon 1, CHU Hôpital, Femme Mère Enfant, Bron, France
| | - Jean-Michel Guys
- Aix-Marseille Université, Marseille, France.,APHM, Service de Chirurgie Pédiatrique, CHU Hôpital Timone, Marseille, France
| | - Gilles Karsenty
- Aix-Marseille Université, Marseille, France.,APHM, Service d'Urologie et de Transplantation Rénale, CHU Hôpital la Conception, Marseille, France
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