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Roth JD, Hensel DJ, Wiener JS, Younsi N, Stein R, Misseri R, Szymanski KM. Urinary and Fecal Incontinence During Sexual Activity Is Common and Bothersome Among Adults With Spina Bifida. Urology 2024; 186:54-60. [PMID: 38354913 DOI: 10.1016/j.urology.2023.12.029] [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: 09/25/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for urinary fecal incontinence (UI, FI) during sexual activity (UIS, FIS) among adults with spina bifida (SB). METHODS An international online survey of adults with SB was administered through SB clinics and SB organizations via social media. Adults with a history of masturbation or partnered sexual activity were included. The primary outcome was ever experiencing UIS/FIS. Nonparametric tests and logistic regression were used for analysis. RESULTS A total of 341 adults met inclusion criteria (median age: 36years, 59% female, 52% shunted, 48% community ambulators). Baseline UI in the last 4weeks was reported by 50% and FI by 41%. Nineteen (5%) had a urostomy. Eight (2%) had a colostomy. Overall, 93% had a history of partnered genital contact. Among adults without a diversion, UIS was more common than FIS (70% vs 45%, P < .001). Among adults without a urostomy, UIS was more common among women (76% vs 62%, P = .01) and those with baseline UI (84% vs 50%, P < .001). UIS was not associated with age, shunt, ambulatory, or catheterization status (P >=.32). On bivariate analysis, female sex and baseline UI were independent predictors of UIS (P <=.001). Among adults without a colostomy, FIS was associated with female sex (50% vs 39%, P = .046), baseline FI (59% vs 32%, P < .001), community ambulation (52% vs 40%, P = .04), but not age, shunt, or MACE status (P >=.27). On multivariate analysis, baseline FI was independently associated with FIS (P < .001). Among adults with UIS/FIS, 29% experienced UIS "almost always" to "always," compared to 5% for FIS (P < .001). Virtually all adults found UIS/FIS bothersome (>=96% for each), even when incontinence occurred "almost never." UIS/FIS mostly occurred before and/or during orgasm than afterward (P < .001). UIS was reported by 53% of adults with a urostomy (100% bothersome). FIS was reported by 38% of adults with a colostomy (100% bothersome). CONCLUSION Incontinence during sexual activity is a common problem for men and women with SB. Baseline incontinence is an independent, but not absolute, predictor of both. While FIS is less frequent than UIS, both are virtually always bothersome.
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Affiliation(s)
- Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University School of Medicine and Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - John S Wiener
- Division of Pediatric Urology, Department of Urology, Duke University Medical Center, Durham, NC
| | - Nina Younsi
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Taskinen S, Mäkelä E. Additional surgery in patients with bladder augmentation. J Pediatr Urol 2023:S1477-5131(23)00124-9. [PMID: 37061366 DOI: 10.1016/j.jpurol.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Bladder augmentation is an option to protect kidneys and treat incontinence in frequent neurogenic and congenital non-neurogenic disorders. However, patients may need also other procedures to treat incontinence or to aid catheterizations. In addition, the patients are prone to complications. OBJECTIVE To evaluate complications or additional surgeries in augmentation cystoplasty according to the etiology of the bladder dysfunction. STUDY DESIGN Data on additional surgical procedures related to bladder augmentation were collected from 128 patients who had undergone enterocystoplasty between 1990 and 2019, with a median age of 10.1 years (IQR 7.2-12.8) and a follow-up time of 11.8 years (IQR 5.7-18.6) after augmentation. RESULTS Eighty-three patients had a neurogenic disease, and 45 patients had a non-neurogenic disease. Bladder neck operations were performed either at the time of or after augmentation for 62 patients (48.4%), more commonly in the non-neurogenic than neurogenic group <0.01. In addition, continent stoma operations in 56 (36.8%) patients were more common in the non-neurogenic group (p < 0.01). Ten patients received kidney transplantation (four in the neurogenic, six in the non-neurogenic group); seven of these patients originally had dysplastic kidneys, two developed nephrological kidney disease, and one had hydronephrosis and renal insufficiency at the time of diagnosis of neurogenic bladder. Surgical problems resulting from bladder augmentation were treated in 28 patients (21.8%). The risk for surgical treatment because of complications was 4%, 17%, 24%, 27% and 27% at 1, 5, 10, 15 and 20 years follow up respectively. Complications were more common in patients in non-neurogenic than in patients with neurogenic group (p < 0.01). However, the greater proportion of continent stomas in non-neurogenic group explained the difference (Fig.). The most frequent complication requiring surgery during follow-up was bladder stones, which occurred in 24 (18.8%) patients. The first stone was treated at a median of 3.3 years (range 0.3-14.2) after augmentation. Stones were more common in patients with a continent stoma than without (p < 0.01). Other indications for surgical treatment were as follows: obstructive ileus in five patients, reduced bladder capacity in three patients, bladder perforation in two patients and lobulated bladder with infections in one patient. CONCLUSIONS The risk for surgical treatment was about 27% in 20-year follow-up after bladder augmentation, because of augmentation related complications. The most prevalent complication was bladder stone, that was mainly associated with continent stomas. Continent stomas were most prevalent in patients with non-neurogenic diagnosis.
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Affiliation(s)
- Seppo Taskinen
- Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Eija Mäkelä
- Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Szymanski KM, Adams CM, Alkawaldeh MY, Austin PF, Bowman RM, Castillo H, Castillo J, Chu DI, Estrada CR, Fascelli M, Frimberger DC, Gargollo PC, Hamdan DG, Hecht SL, Hopson B, Husmann DA, Jacobs MA, MacNeily AE, McLeod DJ, Metcalfe PD, Meyer T, Misseri R, O'Neil J, Rensing AJ, Routh JC, Rove KO, Sawin KJ, Schlomer BJ, Shamblin I, Sherlock RL, Slobodov G, Stout J, Tanaka ST, Weiss DA, Wiener JS, Wood HM, Yerkes EB, Blount J. Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study. J Pediatr Rehabil Med 2023; 16:605-619. [PMID: 38073338 PMCID: PMC10789326 DOI: 10.3233/prm-220086] [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: 07/20/2022] [Accepted: 10/31/2023] [Indexed: 01/01/2024] Open
Abstract
PURPOSE This study aimed to analyze organ system-based causes and non-organ system-based mechanisms of death (COD, MOD) in people with myelomeningocele (MMC), comparing urological to other COD. METHODS A retrospective review was performed of 16 institutions in Canada/United States of non-random convenience sample of people with MMC (born > = 1972) using non-parametric statistics. RESULTS Of 293 deaths (89% shunted hydrocephalus), 12% occurred in infancy, 35% in childhood, and 53% in adulthood (documented COD: 74%). For 261 shunted individuals, leading COD were neurological (21%) and pulmonary (17%), and leading MOD were infections (34%, including shunt infections: 4%) and non-infectious shunt malfunctions (14%). For 32 unshunted individuals, leading COD were pulmonary (34%) and cardiovascular (13%), and leading MOD were infections (38%) and non-infectious pulmonary (16%). COD and MOD varied by shunt status and age (p < = 0.04), not ambulation or birthyear (p > = 0.16). Urology-related deaths (urosepsis, renal failure, hematuria, bladder perforation/cancer: 10%) were more likely in females (p = 0.01), independent of age, shunt, or ambulatory status (p > = 0.40). COD/MOD were independent of bladder augmentation (p = >0.11). Unexplained deaths while asleep (4%) were independent of age, shunt status, and epilepsy (p >= 0.47). CONCLUSION COD varied by shunt status. Leading MOD were infectious. Urology-related deaths (10%) were independent of shunt status; 26% of COD were unknown. Life-long multidisciplinary care and accurate mortality documentation are needed.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Cyrus M Adams
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Paul F Austin
- Division of Urology, Texas Children's Hospital, Houston, TX, USA
| | - Robin M Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Heidi Castillo
- Section of Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Jonathan Castillo
- Section of Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Michele Fascelli
- Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dominic C Frimberger
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | | | - Dawud G Hamdan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah L Hecht
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Betsy Hopson
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Micah A Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew E MacNeily
- Division of Pediatric Urology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Daryl J McLeod
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Joseph O'Neil
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Adam J Rensing
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | | | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Bruce J Schlomer
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isaac Shamblin
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gennady Slobodov
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Jennifer Stout
- Surgery Office of Clinical Research, Duke University, Durham, NC, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John S Wiener
- Division of Urologic Surgery, Duke University, Durham, NC, USA
| | - Hadley M Wood
- Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeffrey Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Age-based risk of end-stage kidney disease in patients with myelomeningocele. J Pediatr Urol 2022; 19:195.e1-195.e7. [PMID: 36628830 DOI: 10.1016/j.jpurol.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We aimed to quantify end-stage kidney disease (ESKD) risk after infancy in individuals with myelomeningocele (MMC) followed by urology in the modern medical era and to assess if ESKD risk was higher after surgery related to a hostile bladder. METHODS We retrospectively reviewed patients with MMC followed by urology at our institution born ≥ 1972 (when clean intermittent catheterization was introduced) past 1 year of age (when mortality is highest, sometimes before establishing urology care). ESKD was defined as requiring permanent peritoneal/hemodialysis or renal transplantation. Early surgery related to hostile bladder included incontinent vesicostomy, bladder augmentation, detrusor Botulinum A toxin injection, ureteral reimplantation, or nephrectomy for recurrent urinary tract infections. Survival analysis and proportional hazards regression were used. Sensitivity analyses included: risk factor analysis with only vesicostomy, timing of surgery, including the entire population without minimal follow-up (n = 1054) and only patients with ≥ 5 years of follow-up (n = 925). RESULTS Overall, 1029 patients with MMC were followed for a median of 17.0 years (49% female, 76% shunted). Seven patients (0.7%) developed ESKD at a median 24.3 years old (5 hemodialysis, 1 peritoneal dialysis, 1 transplantation). On survival analysis, the ESKD risk was 0.3% at 20 years old and 2.1% at 30 years old (Figure). This was ∼100 times higher than the general population (0.003% by 21 years old, p < 0.001). Patients who underwent early surgery for hostile bladder had higher ESKD risk (HR 8.3, p = 0.001, 6% vs. 1.5% at 30 years). On exploratory analyses, gender, birth year, shunt status and wheelchair use were not associated with ESKD risk (p ≥ 0.16). Thirty-year ESKD risk was 10% after early vesicostomy vs. 1.4% among children without one (p = 0.001). Children undergoing bladder surgery between 1.5 and 5 years old had a higher risk of ESKD. No other statistically/clinically significant differences were noted. COMMENT Patients with MMC remain at risk of progressive renal damage throughout life. We relied on the final binary ESKD outcome to quantify this risk, rather than imprecise glomerular filtration rate formulas. Analysis was limited by few people developing ESKD, inconsistent documentation of early urodynamic findings and indications for bladder-related surgery. CONCLUSIONS While ESKD is relatively uncommon in the MMC population receiving routine urological care, affecting 2.1% of individuals in the first 3 decades, it is significantly higher than the general population. Children with poor bladder function are likely at high risk, underlining the need for routine urological care, particularly in adulthood.
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Tran WT, Boxley PJ, Wilcox DT, Vemulakonda VM, Wood D, Rove KO. Retrospective analysis of bladder perforation risk in patients after augmentation cystoplasty using an extraperitoneal approach. J Pediatr Urol 2022; 19:192.e1-192.e8. [PMID: 36585277 DOI: 10.1016/j.jpurol.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Initial management of pediatric patients with neurogenic bladder is focused on clean intermittent catheterization and medical therapies. Those with more hostile or small capacity bladders require surgical intervention including bladder augmentation that can result in significant clinical sequelae. This study examines a rarely described approach wherein the bladder reconstruction is extraperitonealized by bringing bowel segments through a peritoneal window and then closed. OBJECTIVE The aim of this study was to determine if the rate of bladder rupture and subsequent morbidity differed between patients who have undergone an intraperitoneal versus extraperitoneal bladder augmentation. We hypothesized that an extraperitoneal approach reduced the risk of intraperitoneal bladder perforation, downstream Intensive Care Unit (ICU) admission, small bowel obstruction (SBO) requiring exploratory laparotomy, and ventriculoperitoneal (VP) shunt-related difficulties as compared to the standard intraperitoneal technique. METHODS A retrospective chart review was conducted to assess surgical approach and outcomes in patients who underwent bladder augmentation performed between January 2009 and June 2021. Patients were identified through an existing database and manual chart review was conducted to extract data through imaging studies, operative notes, and clinical documentation. The primary outcome was bladder perforation. Secondary outcomes were ICU admission, exploratory laparotomy, and VP shunt externalization, infection, or revision for any cause. Nonparametric statistical analyses were performed. RESULTS A total of 111 patients underwent bladder augmentation with 37 intraperitoneal and 74 extraperitoneal procedures. Median follow up was 5.8 years [IQR 3.0-8.6 years] and did not vary between groups (P = 0.67). Only one patient was found to have a bladder perforation in the intraperitoneal group (log-rank P = 0.154). There were no significant differences in time to post-augmentation ICU admission, exploratory laparotomy, or VP shunt events between the two groups (log-rank P = 0.294, log-rank P = 0.832, and log-rank P = 0.237, respectively). Furthermore, a Kaplan-Meier analysis assessing time to composite complication demonstrated no significant difference between the two techniques (log-rank P = 0.236). DISCUSSION This study provides important data comparing the rate of bladder perforation and subsequent morbidity between intraperitoneal and extraperitoneal bladder augmentation. As expected, with a complex procedure, both groups suffered complications, but these data showed no difference between the two procedures. Rates of prior (abdominal) surgery may influence the decision to perform this procedure extraperitoneal. CONCLUSIONS Outcomes related to bladder perforation and secondary consequences do not differ significantly between patients who had bladder augmentation performed with an intraperitoneal versus extraperitoneal approach. Given the low number of adverse events in this study, larger studies are warranted.
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Affiliation(s)
- Wesley T Tran
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
| | - Peter J Boxley
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Duncan T Wilcox
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Vijaya M Vemulakonda
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Dan Wood
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Kyle O Rove
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
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Nisheljeet S, Azizi AB, Palaniandy K, Ganesan D, Ong TA, Alias A, Rajamanickam R, Atroosh WM, Mohd-Zin SW, Lee-Shamsuddin A, Nivrenjeet S, Lo W, Abdul-Aziz NM. Survey on Untethering of the Spinal Cord and Urological Manifestations among Spina Bifida Patients in Malaysia. CHILDREN 2022; 9:children9071090. [PMID: 35884073 PMCID: PMC9324435 DOI: 10.3390/children9071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida, and the authors of this study sought to investigate the impact of untethering on the urological manifestations of children with a tethered cord, thereby consolidating a previously known understanding that untethering improves bladder and bowel function. Demographic and clinical data were collected via an online questionnaire and convenient sampling techniques were used. A total of 49 individuals affected by spina bifida participated in this study. UTIs were reported based on patients’ observation of cloudy and smelly urine (67%) as well as urine validation (60%). UTI is defined as the combination of symptoms and factoring in urine culture results that eventually affects the UTI diagnosis in spina bifida individuals irrespective of CISC status. Furthermore, 18% of the respondents reported being prescribed antibiotics even though they had no history of UTI. Therefore, indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of future UTIs. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0–35 years of age). All individuals below the age of 5 (100%, n = 14) were seen to have improved urologically after the untethering surgery under the guidance of the Malaysia NTD support group. Improvement was scored and observed using KUB (Kidneys, Ureters and Bladder) ultrasound surveillance before untethering and continued thereafter. Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatments were sought soon after birth and continues into adulthood.
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Affiliation(s)
- Singh Nisheljeet
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Abu Bakar Azizi
- Department of Surgery, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (A.B.A.); (K.P.)
| | - Kamalanathan Palaniandy
- Department of Surgery, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (A.B.A.); (K.P.)
| | - Dharmendra Ganesan
- Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (D.G.); (T.A.O.)
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (D.G.); (T.A.O.)
| | - Azmi Alias
- Department of Neurosurgery, Tunku Abdul Rahman Neuroscience Institute (IKTAR), Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia;
- Department of Pediatric Neurosurgery, Women and Children Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
| | | | - Wahib M. Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Siti Waheeda Mohd-Zin
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Andrea Lee-Shamsuddin
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Singh Nivrenjeet
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
| | - Warren Lo
- Department of Urology, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur 50586, Malaysia
- Correspondence: (W.L.); (N.M.A.-A.)
| | - Noraishah Mydin Abdul-Aziz
- Invertebrate & Vertebrate Neurobiology Lab, Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.N.); (S.W.M.-Z.); (A.L.-S.); (S.N.)
- Correspondence: (W.L.); (N.M.A.-A.)
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Sinha S, Shah M. Augmentation cystoplasty in children with stages III and IV chronic kidney disease secondary to neurogenic bladder. Asian J Urol 2021; 9:313-317. [PMID: 36035352 PMCID: PMC9399548 DOI: 10.1016/j.ajur.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/09/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospitals, Hyderabad, India
- Department of Nephrology, Apollo Hospitals, Hyderabad, India
- Corresponding author. Departments of Urology, Apollo Hospitals, Hyderabad, India.
| | - Mehul Shah
- Department of Urology, Apollo Hospitals, Hyderabad, India
- Department of Nephrology, Apollo Hospitals, Hyderabad, India
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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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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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Szymanski KM, Szymanski AJ, Salama AK, Hains DS, Cain MP, Misseri R. Estimating and tracking renal function in children and adults with spina bifida. J Pediatr Urol 2020; 16:169-177. [PMID: 31956092 DOI: 10.1016/j.jpurol.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Estimated glomerular filtration rate (eGFR) in the general population is stable in children after 2 years of age until adulthood. In the first three decades after age 18, eGFR decreases by 0.3-0.8 ml/min/1.73 m2/year. Little data exists regarding eGFR changes in the spina bifida (SB) population given variability in muscle mass. In the absence of a validated SB-specific eGFR formula, the performance of different eGFR formulas may vary. We performed a cross-sectional study (1) to determine trends in eGFR with increasing age in children and adults with SB and (2) to compare eGFRs calculated using different formulas. METHODS We retrospectively reviewed records of patients 2-50 years old with SB followed at our institution (2014-2019). We determined eGFR using four pediatric formulas (2-17 years: CKiDSCr, CKiDCys, CKiDSCr-Cys, ZappitelliSCr-Cys) and four adult formulas (18 + years: MDRDSCr, CKD-EPISCr, CKD-EPICys, CKD-EPISCr-Cys). One eGFR per patient was included (most recent eGFR for those with serial measurements). Patients were categorized as chronic kidney disease (CKD) stage 2 (eGFR 60-89) and Stage 3+ (<60). Non-parametric tests, linear regression, and Spearman's correlation were used for analysis. RESULTS Among 209 children with SB (median age 10.3 years), depending on the formula used, eGFR decreased by -0.7 to -1.8 ml/min/1.73 m2/year (CKiDCys, CKiDScr, p ≤ 0.001), remained stable (CKiDSCr-Cys, p = 0.41), or increased by +2.7/year (ZappitelliSCr-Cys, p < 0.001) (Figure). The proportion of children with CKD 2 or higher varied between formulas (11.5-58.9%, p < 0.001). Correlations between pediatric formulas were negligible to moderate. Comparing any two formulas, 12.0-65.6% of children were assigned a different CKD stage. Among 164 adults (median age 26.3), eGFR decreased for each formula (range: -1.3 to -2.2/year, p ≤ 0.01) (Figure). The proportion of adults with CKD 2 or higher varied between formulas (9.2-30.5%, p < 0.001). Correlations between adult formulas were moderate to very high. Comparing any two formulas, 8.5-26.8% of adults were assigned a different CKD stage. COMMENT We cannot reliably determine whether eGFR changed during childhood. Among adults, eGFR decreased with age for every formula evaluated at greater than twice the general population rate. Without a validated SB-specific eGFR formula, we are left with formulas providing different results. CONCLUSIONS Estimated GFR among adults with SB appears to deteriorate at a higher rate than in the general population. Due to lack of precision of accepted eGFR formulas in the SB population, this may be a real phenomenon, an artifact of inaccurate eGFR formulas, or both. A validated SB-specific eGFR formula is needed.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA.
| | - Arthur J Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Amr K Salama
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - David S Hains
- Department of Pediatrics, Division of Nephrology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
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The basics of transition in congenital lifelong urology. World J Urol 2020; 39:993-1001. [PMID: 32076821 DOI: 10.1007/s00345-020-03116-z] [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: 08/25/2019] [Accepted: 02/03/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Transition in urology is defined by the process that allows an adolescent or a young adult with a congenital or acquired urogenital anomaly to assume increasing responsibility for their own health care and to become the primary decision maker in their care. METHODS A review of the literature regarding transitional care for lifelong urologic congenital anomalies was performed with the aim of reporting expert opinion when data are non-existent. This review focuses on special considerations for adolescents and young adults with spina bifida, bladder exstrophy, anorectal malformations and differences of sexual development. RESULTS Urologic goals during the transition from childhood to adulthood continue to include attention to the preservation of renal function and optimization of lower urinary tract function. Additional concerns include care to decrease long-term surgical complications (especially after augmentation cystoplasty), to monitor for malignancy, to prepare for sex activity and fertility, and to help the adult patient in decision making. Transition aims to maximize quality of life and independence by ensuring uninterrupted appropriate care through a multidisciplinary approach which varies by geographical location and healthcare setting. Barriers include patient and family factors as well as provider and system related factors. A dedicated team is an important element of successful transition.
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Perrouin-Verbe MA, Léon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phé V. Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: A single-center experience in a multidisciplinary team. Neurourol Urodyn 2018; 38:330-337. [PMID: 30350892 DOI: 10.1002/nau.23857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022]
Abstract
AIM To report the very long-term functional outcomes of augmentation cystoplasty (AC) in adult spina bifida patients. METHODS All consecutive adult spina bifida patients who underwent AC between 1991 and 2008 were enrolled. Early postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed. RESULTS Twenty-eight patients with a median age of 20 years (IQR 17-25) were included. They all underwent AC with a supratrigonal cystectomy (SC). The median follow-up was 13.6 years (IQR 6-16.5). Thirteen early postoperative complications (12 grade I-II, 1 grade III) were observed in 11 patients (39%). Eight patients (29%) had upper urinary tract infections managed with antibiotics, with 2 patients requiring ureteral stents. Bladder stones occurred in 2 patients (7%) and were managed with endoscopy and cystostomy. One bladder perforation was reported. One bladder cancer was observed 26 years after surgery. Creatinine clearance and all urodynamic parameters were significantly improved post-operatively. The overall complication and reoperation rates were 57% and 14%, respectively. At last follow up, the continence rate was 71% (n = 20), with 93% (n = 26) performing intermittent self-catheterization. Quality of life was improved for 71% of patients. CONCLUSION In adult spina bifida population, AC is a high-risk procedure with an overall complication rate of 57% and a reoperation rate of 14%. However, AC is beneficial to the overall health of the patients since it provides a satisfying continence rate, an improvement of quality of life, and long-term protection of the upper urinary tract.
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Affiliation(s)
- Marie-Aimée Perrouin-Verbe
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Priscilla Léon
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | | | - Emmanuel Chartier-Kastler
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
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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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Szymanski KM, Hensel DJ, Wiener JS, Whittam B, Cain MP, Misseri R. Sexual identity and orientation in adult men and women with spina bifida. J Pediatr Rehabil Med 2017; 10:313-317. [PMID: 29125522 DOI: 10.3233/prm-170462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Sexuality has received little attention in spina bifida (SB) care. The aim of this study was to assess sexual identity and orientation in adults with SB. METHODS An international online survey to adults with SB was administered over 10-months (recruitment: SB clinics, SB organizations via social media). Collected data included demographics, sexual identity and orientation. Non-parametric tests were used for analysis. RESULTS Median age of 77 men and 119 women was 35 years old (52.0% shunted, 48.5% community ambulators, 42.3% outside United States). Most commonly, men identified as male (96.1%), while 1.3% each described themselves as female, transgender and other. All women reporting sexual identity identified as female (99.2%), 0.8% not providing an answer. Most men reported heterosexual orientation (89.6%), followed by gay (7.8%) and bisexual (2.6%). Most women reported heterosexual orientation (84.9%), followed by bisexual (10.4%), gay/lesbian (2.5%), asexual (0.8%) and other (1.7%). CONCLUSION As in the general population, sexual identity typically coincides with biological gender. Sexual orientation of adults with SB mirrors the general population. Due to self-selection, these findings likely do not reflect exact prevalence in the SB population.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University School of Medicine and Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - John S Wiener
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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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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Ikeda T, Akiyama S, Kim WJ, Ito S, Yamazaki Y. Prevention of ventriculoperitoneal shunt complications after intraperitoneal urological surgeries. J Pediatr Surg 2017; 52:1169-1172. [PMID: 28277297 DOI: 10.1016/j.jpedsurg.2016.09.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate perioperative management for the prevention of postoperative shunt infection and malfunction after intraperitoneal urological surgery in patients with myelodysplasia and a ventriculoperitoneal shunt. METHODS From 2005 to 2015, 20 consecutive patients with myelodysplasia and a ventriculoperitoneal shunt who underwent intraperitoneal urological surgeries were managed with the same perioperative regimen. Intraperitoneal surgeries involved opening gastrointestinal tracts, including bladder augmentation by enterocystoplasty, creating continent catheterizable channels and Malone antegrade continent enema. We compared results with those from seven previous reports regarding postoperative shunt complications, surgical histories of previous shunt revisions, management of bacteriuria before surgery preoperative bowel preparation, antibiotic regimens, and duration of indwelling drain. RESULTS Of 20 patients, 18 received prior shunt revisions, and 14 had positive urine culture before surgery that was managed with oral antibiotics. Thirteen patients underwent bladder augmentation with ileum, and one underwent augmentation with sigmoid colon. Nineteen patients underwent Malone antegrade continent enema using the appendix. All parenteral antibiotics were stopped on postoperative day 2.5. Mean duration of indwelling peritoneal drain was 2.7days. Mean follow-up period was 59.8months. Neither postoperative shunt infections nor intraperitoneal shunt malfunctions were recognized during follow-up period. CONCLUSIONS This is the first study to evaluate postoperative ventriculoperitoneal shunt complications in patients with myelodysplasia who underwent intraperitoneal urological surgeries with a specific perioperative regimen. Shunt complications are greatly reduced by rigorous perioperative management, including preoperative control of bacteriuria, appropriate administration of prophylactic antibiotics, and early removal of intraperitoneal drains. LEVELS OF EVIDENCE The type of study: Case series with no comparison group, IV.
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Affiliation(s)
- Takashi Ikeda
- Department of Urology, Kanagawa Children's Medical Center
| | - Sayaka Akiyama
- Department of Urology, Kanagawa Children's Medical Center
| | - Woo Jin Kim
- Department of Urology, Kanagawa Children's Medical Center
| | - Susumu Ito
- Department of Neurosurgery, Kanagawa Children's Medical Center
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Hsieh MH, Wood HM, Dicianno BE, Dosa NP, Gomez-Lobo V, Mattoo TK, Misseri R, Norton JM, Sawin KJ, Scal P, Wright JE, Star RA, Bavendam T. Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Urology 2017; 103:261-271. [PMID: 28163084 DOI: 10.1016/j.urology.2016.12.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/02/2016] [Accepted: 12/03/2016] [Indexed: 12/20/2022]
Abstract
Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs.
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Affiliation(s)
- Michael H Hsieh
- Children's National Health System, George Washington University, Washington, DC
| | - Hadley M Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Brad E Dicianno
- University of Pittsburgh Medical Center, Department of Physical Medicine and Rehabilitation, Pittsburgh, PA
| | - Nienke P Dosa
- Center for Development Behavior and Genetics, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY
| | - Veronica Gomez-Lobo
- MedStar Washington Hospital Center/Children's National Medical Center, Georgetown University, Washington, DC
| | - Tej K Mattoo
- Wayne State University School of Medicine, Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Detroit, MI
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Jenna M Norton
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Kathleen J Sawin
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee (UWM), Children's Hospital of Wisconsin (CHW), Milwaukee, WI
| | - Peter Scal
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - James E Wright
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, MD
| | - Robert A Star
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Tamara Bavendam
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Szymanski KM, Cain MP, Hardacker TJ, Misseri R. How successful is the transition to adult urology care in spina bifida? A single center 7-year experience. J Pediatr Urol 2017; 13:40.e1-40.e6. [PMID: 27979598 DOI: 10.1016/j.jpurol.2016.09.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rates of successful transition from adolescent to adult spina bifida (SB) care are unknown. OBJECTIVE We aimed to assess rates and predictors of successful transition from a multidisciplinary SB clinic to a transitional urology clinic (TUC), or a pediatric or adult urologist. STUDY DESIGN We retrospectively reviewed patients discharged from a multidisciplinary SB clinic (2006-2012), collecting demographic and clinical data. At transition, all patients/families were given instructions to arrange an appointment within 12 months. Patients who followed-up within 2 years were classified as transitioned. Logistic regression was used for analysis. RESULTS Of 77 patients discharged at a mean age of 19.1 years, 31 (40.3%) successfully transitioned (mean follow-up 4.7 years). Only 20/41 (48.8%) with prior bladder augmentation, urinary channel, and MACE transitioned. There was no significant change in patients transitioning over time or late catch-up presentations (p = 0.41 see Figure). Transitioned and non-transitioned groups were similar in age, gender, home-to-clinic distance, insurance, ambulation, shunt status, prior non-adherence, emergency room visits, neurosurgery appointments, hospitalizations, and surgeries (including genitourinary reconstruction) before discharge (p = 0.22). Transitioned patients had more pre-discharge appointments with services outside the SB clinic (p = 0.01) and radiographic studies (p < 0.001), but these were not significant on multivariate analysis (p = 0.16). Among those who did not transition, five (6.5%) presented after 2 years, rarely with new complaints (20.0%). Patients without urological follow-up were most likely to visit the emergency room (p = 0.03). DISCUSSION To facilitate continued care and a smooth transition, the TUC was opened across the corridor from the multidisciplinary SB clinic. To our surprise, a low percentage of patients actually transitioned to adult care over the last 7 years. It is a sobering fact that despite offering three different transition models, <50% of patients took advantage of any of them. While none of the predictors we anticipated to be important in a successful transition were statistically significant, potentially because of low statistical power, perhaps others, such as insufficient time to coordinate care, wait times, and lack of adult coordinated care programs, may be more important. We were unable to compare the urologic health of those who did and did not transition, as we relied on medical record data. CONCLUSIONS Only 40% of patients transitioned successfully from a multidisciplinary SB clinic and few presented after 2 years. Patients who transitioned tended to have more active health issues and more radiographic tests prior to discharge. Those followed by a urologist are less likely to use emergency room services.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas J Hardacker
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
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Szymanski KM, Cain MP, Whittam B, Kaefer M, Rink RC, Misseri R. All Incontinence is Not Created Equal: Impact of Urinary and Fecal Incontinence on Quality of Life in Adults with Spina Bifida. J Urol 2017; 197:885-891. [PMID: 28131501 DOI: 10.1016/j.juro.2016.08.117] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We previously reported that the self-reported amount of urinary incontinence is the main predictor of lower health related quality of life in adults with spina bifida. In this study we sought to determine the impact of fecal incontinence on health related quality of life after correcting for urinary incontinence. MATERIALS AND METHODS An international sample of adults with spina bifida was surveyed online in 2013 to 2014. We evaluated fecal incontinence in the last 4 weeks using clean intervals (less than 1 day, 1 to 6 days, 1 week or longer, or no fecal incontinence), amount (a lot, medium, a little or none), number of protective undergarments worn daily and similar variables for urinary incontinence. Validated instruments were used, including QUALAS-A (Quality of Life Assessment in Spina bifida for Adults) for spina bifida specific health related quality of life and the generic WHOQOL-BREF (WHO Quality of Life, short form). Linear regression was used (all outcomes 0 to 100). RESULTS Mean age of the 518 participants was 32 years and 33.0% were male. Overall, 55.4% of participants had fecal incontinence, 76.3% had urinary incontinence and 46.9% had both types. On multivariate analysis fecal incontinence was associated with lower bowel and bladder health related quality of life across all amounts (-16.2 for a lot, -20.9 for medium and -18.5 for little vs none, p <0.0001) but clean intervals were not significant (-4.0 to -3.4, p ≥0.18). Conversely, health related quality of life was lower with increased amounts of urinary incontinence (-27.6 for a lot, -18.3 for medium and -13.4 for little vs none, p <0.0001). Dry intervals less than 4 hours were not associated with lower health related quality of life (-4.6, p = 0.053) but the use of undergarments was associated with it (-7.5 to -7.4, p ≤0.01). Fecal incontinence and urinary incontinence were associated with lower WHOQOL-BREF scores. CONCLUSIONS Fecal incontinence and urinary incontinence are independent predictors of lower health related quality of life in adults with spina bifida. Health related quality of life is lower with an increasing amount of urinary incontinence. Fecal incontinence has a more uniform impact on health related quality of life regardless of frequency or amount.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
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Weiss DA. Editorial Comment. Urology 2016; 97:170-171. [DOI: 10.1016/j.urology.2016.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pediatric Bladder Reconstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Neurogenic bladder is a heterogeneous entity that may result from a variety of conditions affecting the central or peripheral nervous systems. Regardless of etiology, the overall goals of management are primarily twofold. As a neurogenic bladder may affect the ability to store urine safely and to empty the bladder efficiently, early management is focused on optimization of bladder storage function to prevent irreversible injury to either the upper or lower urinary tracts. In older children, this goal is added to the challenge of maximizing quality of life through achievement of urinary continence and independence in bladder management that continues into the transition to adulthood. In this review, we seek to bring the reader up-to-date regarding management of the pediatric neurogenic bladder with a focus on literature published in the past year. We discuss key contributions related to fetal intervention for myelomeningocele, monitoring and medical management of the neurogenic bladder and prediction of postoperative outcomes. Put together, these studies highlight the continued need for further research to improve evidence-based medical and surgical decision-making strategies for children affected by neurogenic bladder.
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Affiliation(s)
- Renea M. Sturm
- Division of Urology, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 24, Chicago, IL 60611 USA
- Department of Urology, Feinberg School of Medicine at Northwestern University, 303 E. Chicago Ave, Chicago, IL 60611 USA
| | - Earl Y. Cheng
- Division of Urology, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 24, Chicago, IL 60611 USA
- Department of Urology, Feinberg School of Medicine at Northwestern University, 303 E. Chicago Ave, Chicago, IL 60611 USA
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Wang HHS, Lloyd JC, Wiener JS, Routh JC. Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida. J Urol 2016; 195:1189-94. [PMID: 26926542 PMCID: PMC4826303 DOI: 10.1016/j.juro.2015.11.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE Bladder dysfunction in patients with spina bifida can lead to significant morbidity due to renal insufficiency. Indications for surgery vary among institutions and the impact is unclear. We examined trends and variations in urological interventions and chronic renal insufficiency in patients with spina bifida. MATERIALS AND METHODS We reviewed NIS (Nationwide Inpatient Sample) for all patients with spina bifida treated from 1998 to 2011. We used ICD-9-CM codes to identify urological surgery and chronic renal insufficiency. We calculated the Spearman correlation coefficients between rates of spina bifida related bladder surgeries and rates of chronic renal insufficiency outcomes by state. Linear regression models were fitted to investigate the associations between rates of spina bifida related surgery and chronic renal insufficiency across treatment years. RESULTS We identified 427,616 spina bifida hospital admissions. Mean patient age was 26 years and 56% of patients were female. Of the admissions 35,249 (8%) were for chronic renal insufficiency and 11,078 (3%) were for surgery. During the study period chronic renal insufficiency rates doubled from 6% to 12% and surgery rates decreased from 2.0% to 1.8%. There was a moderately weak inverse association between surgery and chronic renal insufficiency rates with time (r = -0.3, p = 0.06) and by state (r = -0.3, p = 0.04). On multivariate analysis higher rates of surgery were associated with the state in which the patient was treated (p <0.001), and with younger age (p <0.001) and hospital teaching status (p <0.001). In contrast, chronic renal insufficiency was not associated with spina bifida related surgery (p = 0.67). CONCLUSIONS We observed a temporal and geographic trend toward decreasing urological surgery and increasing chronic renal insufficiency rates in spina bifida and a wide variation in urological surgical rates among states. Further study is needed to determine the factors behind these trends and variations in spina bifida management.
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Affiliation(s)
- Hsin-Hsiao S Wang
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Jessica C Lloyd
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
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Quantity, Not Frequency, Predicts Bother with Urinary Incontinence and its Impact on Quality of Life in Adults with Spina Bifida. J Urol 2016; 195:1263-9. [DOI: 10.1016/j.juro.2015.07.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/22/2022]
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Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol 2016; 5:12-21. [PMID: 26904408 PMCID: PMC4739982 DOI: 10.3978/j.issn.2223-4683.2016.01.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Neurogenic bladder (NGB) has long been defined as a clinical entity that describes a heterogeneous collection of syndromes. The common theme is a bladder disorder concomitant with a neurologic disorder. This definition does not give the clinician much information about the bladder disorder, nor how to treat it, or even what the natural history of the disorder is likely to be. It may be time for a new classification scheme to better define the bladder defect and prognosis, as well as inform treatment. We propose a classification system based on seven categories, each having a neurologic defect in a distinct anatomic location. This is termed SALE (Stratify by Anatomic Location and Etiology). In addition, the presence or absence of bowel dysfunction and autonomic dysreflexia will be reported. In the future, as more definite prognostic information can be gleaned from biomarkers, we anticipate adding urinary nerve growth factor (NGF) and urinary brain-derived neurotrophic factor (BDNF) levels to the definition. We expect the SALE system to efficiently describe a patient suffering from NGB and simultaneously inform the most appropriate treatment, follow-up regimen, and long-term prognosis.
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Affiliation(s)
- Charles R Powell
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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McNamara ER, Kurtz MP, Schaeffer AJ, Logvinenko T, Nelson CP. 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: A NSQIP pediatric analysis. J Pediatr Urol 2015; 11:209.e1-6. [PMID: 26049255 PMCID: PMC4540660 DOI: 10.1016/j.jpurol.2015.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures. Although there is literature identifying long-term outcomes in these patients, the reporting of short-term postoperative outcomes has been limited by small numbers of cases and lack of prospective data collection. Here we report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these procedures. OBJECTIVE To determine 30-day complication, readmission and reoperation after augmentation enterocystoplasty and appendicovesicostomy in a large national sample of pediatric patients, and to explore the association between preoperative and intraoperative characteristics and occurrence of any 30-day event. STUDY DESIGN We queried the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS-NSQIPP) for all patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy. Surgical risk score was classified on a linear scale using a validated pediatric-specific comorbidity score. Intraoperative characteristics and postoperative 30-day events were reported from prospectively collected data. A composite measure of complication, readmission and/or reoperation was used as primary outcome for the multivariate logistic regression. RESULTS There were 461 patients included in the analysis: 245 had appendicovesicostomy, 97 had augmentation enterocystoplasty and 119 had both procedures. There were a total of 110 NSQIP complications seen in 87 patients. The most common complication was urinary tract infection (see Table for 30-day outcomes by patient). The composite measure of any 30-day event was seen in 27.8% of the cohort and this was associated with longer operative time, increased number of procedures done at time of primary surgical procedure and higher surgical risk score. DISCUSSION The ACS-NSQIPP provides a tool to examine short-term outcomes for these complex urologic procedures that has not been possible before. Although ACS-NSQIP has been used extensively in the adult surgical literature to identify rates of complications, and to determine predictors of readmission and adverse events, its use in pediatric surgery is new. As in the adult literature, the goal is for standardization of practice and transparency in reporting outcomes that may lead to reduction in morbidity and mortality. CONCLUSION In this cohort, any 30-day event is seen in almost 30% of the patients undergoing these urologic procedures. Operative time, number of concurrent procedures and higher surgical risk score all are associated with higher odds of the composite 30-day event of complication, readmission and/or reoperation. These data can be useful in counseling patients and families about expectations around surgery and in improving outcomes.
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Affiliation(s)
- Erin R McNamara
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA; Harvard-wide Pediatric Health Services Research Fellowship, Boston, MA, USA.
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA.
| | - Anthony J Schaeffer
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA.
| | - Tanya Logvinenko
- Center for Clinical Research, Boston Children's Hospital, Harvard Medical School, Boston, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA.
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This Month in Pediatric Urology. J Urol 2015. [DOI: 10.1016/j.juro.2014.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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