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Maxon V, Haffar A, Michel CA, Hirsch AM, Robey C, Heap D, Galansky L, Gearhart J, Di Carlo H, Crigger CB. A Rocky Road: Bladder Stones in the Augmented Exstrophy-Epispadias Complex Patient. Urology 2024:S0090-4295(24)00558-2. [PMID: 38986957 DOI: 10.1016/j.urology.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To determine the rate of stone formation amongst patients of the exstrophy-epispadias complex with augmentation cystoplasty. We hypothesize that bowel segment choice influences the rate of stone formation after bladder augmentation and the rate of complications from bladder stone surgery. METHODS An IRB approved institutional database of 1512 exstrophy-epispadias patients was reviewed retrospectively. Patients that had a history of bladder augmentation and were seen at our institution between 2003 and 2023 were included. RESULTS Out of 259 patients, bladder stones developed in 21.6% (56), of which the bowel segment used was colon in 147 patients and ileum in 100. Stones formed in 19% of colon augments compared to 29% ileal augments, however this was not statistically significant (p=0.07). The most common primary stone component was dahllite, followed by struvite for all augments. The median time to stone treatment after augmentation was 4.14 years (0.75-31). 74% of patients had a recurrence that required a second surgery. The median time from first to second surgery and second to third surgery was 1.4 years and 2.22 years, respectively. Bladder stone surgery complications occurred in 14% of patients, vesicocutaneous fistula being the most common, and complications did not differ by augment type. Median follow up after first stone intervention was 6.07 years (0-19.5). CONCLUSION The treatment of bladder stones in the exstrophy-epispadias complex remains challenging. Interventions to prevent recurrence are crucial as the majority of patients will require two or more stone surgeries in their lifetime.
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Affiliation(s)
- Victoria Maxon
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Ahmad Haffar
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
| | - Chloe A Michel
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Alexander M Hirsch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Catherine Robey
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - David Heap
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Logan Galansky
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - John Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Heather Di Carlo
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Chad B Crigger
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
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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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Kamal W, Azhar RA, Hamri SB, Alathal AH, Alamri A, Alzahrani T, Abeery H, Noureldin YA, Alomar M, Al Own A, Alnazari MM, Alharthi M, Awad MA, Halawani A, Althubiany HH, Alruwaily A, Violette P. The Saudi urological association guidelines on urolithiasis. Urol Ann 2024; 16:1-27. [PMID: 38415236 PMCID: PMC10896325 DOI: 10.4103/ua.ua_120_23] [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: 12/22/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Abstract
Aims The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia. Panel The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest. Methods The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.
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Affiliation(s)
- Wissam Kamal
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulaziz H Alathal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alamri
- Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Tarek Alzahrani
- Dr. Sulaiman Al Habib Hospital (Swaidi), Riyadh, Saudi Arabia
| | | | - Yasser A Noureldin
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Urology, Faculty of Medicine, Benha University, Egypt
- Department of Clinical Sciences, Northern Ontario School of Medicine, ON, Canada
| | - Mohammad Alomar
- Department of Urology, King Fahad Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mansour M Alnazari
- Department of Urology, College of Medicine, Taibah university, Madinah, Saudi Arabia
| | - Majid Alharthi
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
- Seoul National University Hospital, Seoul, South Korea
| | - Mohannad A Awad
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
- Department of Urology, University of Texas Southwestern Medical Southwestern Medical Centre, Dallas, TX, USA
| | - Abdulghafour Halawani
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatem Hamed Althubiany
- Department of Urology, Imam Abdulrahman Bin Faisal University, Dammam King Fahd Hospital of the University, Dammam, Saudi Arabia
| | | | - Phillipe Violette
- Woodstock General Hospital, London Ontario, Canada
- McMaster University, London Ontario, Canada
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Moazin M, Altulayqi W, Tolah H, Alkeraithe F. A successful open neocystolithotomy in studer neobladder with Mitrofanoff for multiple large neobladder stones: A case report and review of the literature. Urol Case Rep 2023; 50:102474. [PMID: 37455777 PMCID: PMC10338960 DOI: 10.1016/j.eucr.2023.102474] [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: 05/10/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Urolithiasis is a rare complication of orthotopic neobladder after cystectomy. We report a case of a 25-year-old female with studer neobladder and Monti valve presenting with recurrent urinary tract infections, abdominal pain, and difficult catheterization. Imaging revealed multiple large stones in the neobladder. Neocystolitholapaxy and neocystolithotripsy failed, leading to an open neocystolithotomy with retrieval of 14 large stones. Stone composition analysis showed struvite (30%), carbonate apatite (46%), and whitlockite (24%). Neobladder repair with omental interposition was performed. Follow-up confirmed an intact neobladder without leaks. Neobladder stones may be asymptomatic, and open neocystolithotomy is an effective treatment for multiple neobladder stones.
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Affiliation(s)
- Maher Moazin
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Waleed Altulayqi
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hamza Tolah
- Alrayan Medical Colleges, Medina, Saudi Arabia
| | - Fawaz Alkeraithe
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
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Burns R, Hardesty J, Schmidt J, Risk N, Vasquez R, Soyster M, Mellon M, Rivera M. Percutaneous Cystolitholapaxy Is Safe and Effective in Adult Patients With Lower Urinary Tract Reconstruction Utilizing Bowel. Urology 2023; 178:37-41. [PMID: 37150405 DOI: 10.1016/j.urology.2023.04.024] [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: 01/22/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To investigate the safety, efficacy, and surgical approach of percutaneous bladder calculi removal in adult patients with prior lower urinary tract reconstruction utilizing bowel using a single-institution database. METHODS Twenty patients with prior history of lower urinary tract reconstruction (continent cutaneous urinary reservoir, augmentation enterocystoplasty with catheterizable channel, or ileal neobladder) who underwent percutaneous cystolitholapaxy from 2014 to 2020 were identified from an IRB-approved database. Analysis of patient demographics, operative details, stone composition, stone-free rates, recurrence, and associated complications was performed. RESULTS Percutaneous access and either ultrasonic lithotripter or laser lithotripsy were utilized to remove bladder stones. Over half of the patients also underwent concomitant renal stone removal via percutaneous removal or retrograde ureteroscopy. Postoperative computed tomography imaging revealed complete bladder stone clearance in 90% of patients. There were no notable complications from percutaneous bladder stone removal and most patients were discharged either the same day or within 24hours. Urine and stone analysis revealed infection was present in the majority of patients. Bladder stones recurred in 45% of patients after more than 2years of follow-up, on average. CONCLUSION Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution.
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Affiliation(s)
- Ramzy Burns
- Department of Urology, Indiana University, Indianapolis, IN.
| | | | | | - Nathan Risk
- Indiana University School of Medicine, Indianapolis, IN
| | - Ruben Vasquez
- Department of Urology, Indiana University, Indianapolis, IN
| | - Mary Soyster
- Department of Urology, Indiana University, Indianapolis, IN
| | - Matthew Mellon
- Department of Urology, Indiana University, Indianapolis, IN
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The exstrophy experience: A national survey assessing urinary continence, bladder management, and oncologic outcomes in adults. J Pediatr Urol 2022; 19:178.e1-178.e7. [PMID: 36456414 DOI: 10.1016/j.jpurol.2022.11.014] [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: 02/08/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE The bladder exstrophy-epispadias complex (BEEC) is a rare spectrum of congenital genitourinary malformations with an incidence of 1:10,000 to 1:50,000. Advances in reconstructive surgical techniques have improved clinical outcomes, but there is a paucity in data about disease sequela in adulthood. This is the largest survey to date in the United States exploring the urinary continence, bladder management, and oncologic outcomes in adults with BEEC. METHODS Respondents were over the age of 18 with a diagnosis of bladder exstrophy, cloacal exstrophy, or epispadias. They were treated at the authors' institution, included in the Association for the Bladder Exstrophy Community (A-BE-C) mailing list, and/or engaged in A-BE-C social media. A survey was created using uniquely designed questions and questionnaires. Survey responses between May 2020 and July 2020 were processed using Research Electronic Data Capture (REDCap). Quantitative and qualitative statistics were used to analyze the data with significance at p < 0.05. RESULTS A total of 165 patients completed the survey. The median age was 31.5 years (IQR 25.9-45.9). Many patients considered themselves continent of urine, with a median satisfaction score of 74 (IQR 50-97) on a scale from 0 (consider themselves to be completely incontinent) to 100 (consider themselves to be completely continent). There was less leakage among those with a continent urinary diversion compared to those who void or catheterize per urethra (p = 0.003). Patients with intestinal-urinary tract reconstruction, such as augmentation cystoplasty or neobladder creation, were more likely to perform bladder irrigations (p = 0.03). Patients with continent channels were more likely to report UTI than all other forms of bladder management (89.0% vs. 66.2%, p = 0.003). Three (1.9%) patients were diagnosed with bladder cancer. A small portion of patients (27.2%) were given bladder cancer surveillance recommendations by a physician. DISCUSSION Most patients achieved a satisfactory level of urinary continence, with the highest continence rates in those with a continent urinary diversion. Those with intestinal-urinary tract reconstruction were more likely to perform bladder irrigations, perhaps to avoid complications from intestinal mucous production. The rates of self-reported UTI and were higher in patients with continent channels, but recurrent UTIs were not affected by the type of genitourinary reconstruction. Bladder cancer exists in this population, highlighting the need for long-term follow-up. CONCLUSION Most BEEC patients achieve a satisfactory level of urinary continence, with the best outcomes in those with a continent urinary diversion. This population requires long-term follow-up with a transitional urologist to ensure adequate oncologic care.
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Altan M, Bozacı AC, Asci A, Dogan HS, Tekgul S. Autoaugmentation: A Feasible Option before Ileal Augmentation in Selected Cases. Eur J Pediatr Surg 2022; 32:370-375. [PMID: 34823263 DOI: 10.1055/s-0041-1739419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of autoaugmentation (AA) in pediatric population. MATERIALS AND METHODS The data of 59 patients (32 females and 27 males) who underwent AA between 1993 and 2018 were analyzed retrospectively. During postoperative follow-up, deterioration on renal scan and/or nonimproved hydronephrosis (HN) were described as upper urinary tract (UUT) impairment. Incontinence was described as use of diaper or pad. Preoperative urodynamic volume was divided into two as less than 50 and more than or equal to 50% expected bladder capacity (EBC). The effect of preoperative clinical factors on reaugmentation, incontinence, and UUT impairment was evaluated. RESULTS The mean age and the median follow-up were 8.9 ± 3.6 years and 64 (12-218) months, respectively. Ten (16.9%) patients underwent reaugmentation (ureteral or ileal). UUT impairment and incontinence rates were 13.6% (8/59) and 30.5% (18/59), respectively. On multivariate analysis, less than 50% EBC was the only predictor of reaugmentation and incontinence (p = 0.013, odds ratio [OR]: 17.546 and p = 0.035, OR: 3.750, respectively). Preoperative HN was predictor of UUT impairment (p = 0.041, OR: 10.168). After AA, 51 patients used clean intermittent catheter and 27 (45.8%) patients discontinued the use of anticholinergic medication. At follow-up, eight (13.5%) patients underwent surgery after AA due to long-term complications, dissatisfaction, or poor functional results (bladder neck injection, cystolithotripsy, Mitrofanoff revision, dilatation, and injection). CONCLUSION AA is a viable option in selected cases with high pressure and low compliant bladders. Preoperative bladder capacity is significant for reaugmentation rate and continence. UUT impairment is related to preoperative HN.
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Affiliation(s)
- Mesut Altan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Cansu Bozacı
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Herschorn S, Locke J, Vigil H. Hemi-Kock Continent Stoma With Augmentation Cystoplasty: Modifications and Outcomes. Urology 2021; 160:217-222. [PMID: 34910923 DOI: 10.1016/j.urology.2021.10.004] [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: 08/16/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the long-term outcomes and impact of surgical modifications on the need for secondary surgery of the Hemi-Kock continent catheterizable stoma, comprising a detubularized ileal segment with an attached stapled ileoileal intussusception of the catheterizable channel, in patients with complex lower urinary tract disorders. The technique may be used for augmentation in patients with reduced bladder capacity who require a continent catheterizable channel. Compared to the flap and ileocecal valve procedures, the hemi-Kock technique has not been widely adopted. MATERIALS AND METHODS This is a retrospective case series including all patients who underwent a hemi-Kock catheterizable channel with cystoplasty from a single institution. Surgical technique and modifications in valve construction and tapering of the catheterizable limb are described. RESULTS A total of 109 patients, with a median age of 38 years (range 18-72), underwent the procedure. At a mean of 10.4 years, 98 patients (90%) reported that they were managing with clean intermittent catheterization ± pads; 11 (10%) were failures. A total of 70 (64.2%) patients underwent secondary interventions with >60% performed endoscopically or under local anesthesia, mainly for bladder stones. Fourteen patients (12.8%) required valve revisions. However, the rate decreased from 18.2% (8/44) to 9.3% (6/65) following incorporation of the surgical modifications. CONCLUSION We present the largest cohort to date of patients managed with a Hemi-Kock catheterizable channel and cystoplasty. Valve revision rate improved with surgical modifications. We demonstrate long-term durability and maintenance of stomal catheterization in the vast majority of patients.
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Affiliation(s)
- Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Jennifer Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Humberto Vigil
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Tafuri A, Presicce F, Sebben M, Cattaneo F, Rizzetto R, Ferrara F, Bondurri A, Veltri M, Barbierato M, Pata F, Forni C, Roveron G, Rizzo G, Parini D. Surgical management of urinary diversion and stomas in adults: multidisciplinary Italian panel guidelines. Minerva Urol Nephrol 2021; 74:265-280. [PMID: 34114787 DOI: 10.23736/s2724-6051.21.04379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urinary stomas represent a worldwide medical and social problem. Data from literature about stoma management are extensive, but inhomogeneous. No guidelines exist about this topic. So, clear and comprehensive clinical guidelines based on evidence-based data and best practice are needed. This article aims to elaborate guidelines for practice management of urinary stomas in adults. METHODS Experts guided review of the literature was performed in PubMed, National Guideline Clearing-house and other databases (updated March 31, 2018). The research included guidelines, systematic reviews, meta-analysis, randomized clinical trials, cohort studies and case reports. Five main topics were identified: "stoma preparation", "stoma creation", "stoma complications", "stoma care" and "stoma reversal". The systematic review was performed for each topic and studies were evaluated according to the GRADE system, AGREE II tool. Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low level of scientific evidence statements a consensus conference composed by expert members of the major Italian scientific societies in the field of stoma management and care was performed. RESULTS After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines with definitive recommendations was elaborated and prepared for publication. This manuscript is focused on statements about surgical management of urinary stomas. These guidelines include recommendations for adult patients only, articles published in English or Italian and with complete text available. CONCLUSIONS These guidelines represent the first Italian guidelines about urinary stoma multidisciplinary management with the aim to assist urologists and stoma specialized nurses during the urinary stoma management and care.
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Affiliation(s)
- Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy - .,Department of Neuroscience, Imaging and Clinical Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy -
| | | | - Marco Sebben
- Department of Urology, Ospedale Sacro Cuore Don Calabria IRCCS, Negrar, Verona, Italy
| | - Francesco Cattaneo
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Francesco Ferrara
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Andrea Bondurri
- Department of General Surgery, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Marco Veltri
- General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
| | | | - Francesco Pata
- General Surgery Unit, N. Giannettasio Hospital, Corigliano-Rossano, Cosenza, Italy
| | - Cristiana Forni
- Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gabriele Roveron
- Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rizzo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Dario Parini
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
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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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Pavlović K, Hrkać A, Kožul IS, Zalihić D, Zalihić A, Gilja I. Long-term results of augmentation ileocystoplasty in spinal cord injury patients. Cent European J Urol 2021; 74:178-184. [PMID: 34336235 PMCID: PMC8318013 DOI: 10.5173/ceju.2021.0333.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this article was to report the long-term results of increased ileocystoplasty in 58 patients with spinal cord injury (SCI) with an impact on overall renal function and quality of life. In a representative number of patients, where we followed individual subjects for more than 20 years, we wanted to determine their quality of life and preservation of renal function after surgery. MATERIAL AND METHODS After unsuccessful conservative therapy of urinary incontinence, increased ileocystoplasty was performed. In addition to biochemical analysis, intravenous urography (IVU) was performed preoperatively (urography and/or ultrasound assessment of the upper urinary tract) and urodynamic tests were performed in all patients preoperatively. RESULTS After a follow-up of patients within the group (>20 years), 2 patients reported being incontinent. The median elapsed time of action was 20 (13-24) years. Vesical capacity increased in all cases postoperatively when the median vesical capacity was 420.0 (387.5-460.0) ml (p <0.001). Long-term complications included use of bladder chambers, kidney stones and urosepsis. Creatinine clearance confirmed satisfactory renal function after the elapsed time period from surgery. CONCLUSIONS The results confirmed that augmentation ileocystoplasty had excellent long-term outcomes in the definitive therapy of refractory neurogenic detrusor overactivity in patients with SCI.
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Affiliation(s)
- Katica Pavlović
- University Clinical Hospital in Mostar, Clinic of Urology, Mostar, Bosnia and Herzegovina
| | - Adelina Hrkać
- Clinical Hospital, Department of Urology, 'Sveti Duh', Zagreb, Croatia
| | | | - Dino Zalihić
- University Clinical Hospital in Mostar, Clinic of Urology, Mostar, Bosnia and Herzegovina
| | - Amra Zalihić
- University of Mostar, Faculty of Medicine, Mostar, Bosnia and Herzegovina
| | - Ivan Gilja
- University Clinical Hospital in Mostar, Clinic of Urology, Mostar, Bosnia and Herzegovina
- Clinical Hospital, Department of Urology, 'Sveti Duh', Zagreb, Croatia
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12
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Paediatric cystolitholapaxy using mini PCNL-kit through the Mitrofanoff stoma. Ann Med Surg (Lond) 2021; 62:88-91. [PMID: 33505678 PMCID: PMC7815490 DOI: 10.1016/j.amsu.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/09/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022] Open
Abstract
Bladder stones are a common complication after augmentation cystoplasty and urinary diversion. However, the treatment of recurrent cystolithiasis in neuropathic children remains a real challenge for urologists and open procedures may be associated with significant morbidity. Currently, mini-invasive management options are available in the therapeutic armamentarium. Herein, we reported a case of Mitrofanoff cystolitholapaxy using a mini PCNL-kit, in a 14-year-old patient with the history of neurogenic bladder due to myelomeningocele managed by bladder augmentation. This technique has been previously described but we have added a unique modification using Nelaton catheter for carefully dilating the Mitrofanoff stoma before inserting an Amplatz sheeth and we report tips and tricks to guarantee a stone free status with one single procedure. Using high energy Holmium laser, this approach is safe and effective even with large stone burden. The treatment of cystolithiasis in neuropathic patients with a bladder-neck closure represents a surgical challenge. Open cystolithotomy is a good option to treat large stone burdens or multiple calculi. For recurrent stones, endoscopic treatment via a catheterizable channel is an effective option, especially for patients with a closed bladder neck and low-burden stone. Dilating the channel is the key step. Using serially Nelaton catheter (10-16Fr) is a good trick to preserve the integrity of the Mitrofanoff stoma.
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13
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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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14
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Peycelon M, Szymanski KM, Francesca Monn M, Salama AK, Risk H, Cain MP, Misseri R. Adherence with bladder irrigation following augmentation. J Pediatr Urol 2020; 16:33.e1-33.e8. [PMID: 31796294 DOI: 10.1016/j.jpurol.2019.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with bladder augmentation (BA) are routinely counseled to irrigate their bladders daily. However, reports of adherence with this regimen are lacking. OBJECTIVE To evaluate adherence to a bladder irrigation protocol and identify risk factors associated with adherence among adults with spina bifida (SB) and BA. STUDY DESIGN Adults with SB after BA followed in a multidisciplinary clinic were identified (2017-2019). All patients or caregivers were taught the importance of and the technique for the bladder irrigation protocol prior to and after BA. Patient demographics (age, gender, ambulatory status, and presence of a caregiver in clinics) and surgical details (type of BA, age at surgery, length of follow-up, presence of a catheterizable channel, position of stoma, bladder neck surgery, presence of Malone antegrade colonic enema or ventriculo-peritoneal shunt, and number of stone surgeries) were obtained from the medical record. Patients reported other variables in a standardized clinic questionnaire. Answers were confirmed by health care providers. The variables included who performs clean intermittent catheterization (CIC), size of catheter, frequency of CIC, use of overnight catheterization, difficulties with CIC, number of UTIs, and continence per urethra and per catheterizable channel. Adherence to bladder irrigation was also assessed in the questionnaire. ‛Strict adherence' was defined as bladder irrigation performed ≥6 times/week with ≥120 mL of saline. For statistical analysis, a more lenient definition of ‛higher adherence' was used: bladder irrigation ≥2 times/week with at least 60 mL. ‛Lower adherence' was defined as ≤1 time/week or with less than 60 mL. Factors associated with ‛higher adherence' were assessed with non-parametric tests (Bonferroni-corrected p-value: 0.002). RESULTS Adherence was assessed in 87 eligible patients (60.9% females; mean age of 28.8 ± 8.2 years). No patient (0.0%) reported ‛strict adherence', and 62 and 25 patients (71.3% and 28.7%) reported ‛higher' and ‛lower' adherence' to bladder irrigation, respectively. Nine patients (10.3%) in the ‛lower adherence' group did not irrigate at all. No variables were statistically significant on univariate analysis, including previous bladder stone surgery or having a channel (p ≥ 0.01). On exploratory analysis, higher adherence was only associated with self-catheterizations versus those performed by caregivers (76.7% vs 33.3%, p = 0.01). CONCLUSIONS Adherence to a bladder irrigation protocol in adults with SB and BA is poor. A history of bladder stones requiring surgery and the presence of a catheterizable channel do not appear to affect adherence. It remains unclear why some patients are more likely than others to irrigate their bladders. Future work will focus on methods to improve adherence.
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Affiliation(s)
- Matthieu Peycelon
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA; Reference Center for Rare Diseases (CRMR), Malformations Rares des Voies Urinaires (MARVU), Université de Paris, Sorbonne Paris Cité. 48, Boulevard Sérurier, Paris, France
| | - Konrad M Szymanski
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - M Francesca Monn
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Amr K Salama
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Hillary Risk
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Mark P Cain
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Rosalie Misseri
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA.
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Ross JPJ, Keays M, Neville C, Leonard M, Guerra L. Pediatric bladder augmentation - Panacea or Pandora's box? Can Urol Assoc J 2020; 14:E251-E256. [PMID: 31977304 DOI: 10.5489/cuaj.6024] [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]
Abstract
INTRODUCTION Bladder augmentation is a surgery that can increase bladder capacity and compliance. The objective of this study was to provide a longitudinal review of pediatric bladder augmentation at a tertiary Canadian center. METHODS A retrospective review was performed on patients who underwent bladder augmentation at a tertiary pediatric hospital between 1986 and 2014. The primary objective was short- and long-term complications of augmentation. Secondary objectives were to review number of augmentation procedures performed over time and the utility of routine postoperative cystograms. RESULTS A total of 56 procedures were performed on 54 patients (28 males, 26 females) of mean age 10 years (standard deviation [SD] 5) and mean followup eight years (SD 5). The most common bowel segment used was ileum (87.5%). Twenty-eight patients (50%) received catheterizable channels. Overall complication rate was 15% and the most common complications were urinary tract infections (68.5%), worsening hydronephrosis (14.8%), bladder stone formation (14%), and hematuria (13%). In total, 19 of 54 (35.2%) patients returned to the operating room. The incidence of bladder perforation was 3.6%. Complications with the catheterizable channel occurred in 13 of 28 (46.4%), of which 10 were related to stomal stenosis. Forty patients had postoperative cystograms and extravasation was seen in three (7.5%). There was no malignancy during the followup. Only four augmentations were performed from 2008-2014. CONCLUSIONS Bladder augmentation likely represents a safe surgical treatment option. Extravasation on postoperative cystogram was uncommon and, thus, it may not be indicated routinely. The number of augmentation procedures performed has declined in recent years.
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Affiliation(s)
- James P J Ross
- Children's Hospital of Eastern Ontario (CHEO), Department of Surgery, Division of Urology, University of Ottawa, ON, Canada
| | - Melise Keays
- Children's Hospital of Eastern Ontario (CHEO), Department of Surgery, Division of Urology, University of Ottawa, ON, Canada
| | - Christopher Neville
- Children's Hospital of Eastern Ontario (CHEO), Department of Surgery, Division of Urology, University of Ottawa, ON, Canada
| | - Michael Leonard
- Children's Hospital of Eastern Ontario (CHEO), Department of Surgery, Division of Urology, University of Ottawa, ON, Canada
| | - Luis Guerra
- Children's Hospital of Eastern Ontario (CHEO), Department of Surgery, Division of Urology, University of Ottawa, ON, Canada
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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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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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Dantas RAF, Calisto FCFS, Vilar FO, Araujo LAP, Lima SVC. Nonsecretory intestinocystoplasty: postoperative outcomes of 25 years. Int Braz J Urol 2019; 45:681-685. [PMID: 31184453 PMCID: PMC6837613 DOI: 10.1590/s1677-5538.ibju.2018.0595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of bladder augmentation (BA) is to create a low-pressure reservoir with adequate capacity. Despite its benefits, the use of intestinal patches in bladder enlargement provides a high risk of developing complications and BA with demucosalised bowel represents a potential alternative. Therefore, this study evaluated urological parameters and long-term clinical follow-up of patients submitted to nonsecretory BA in a single center with 25 years of experience. MATERIALS AND METHODS Patients treated with BA underwent urological evaluation, which included history, physical examination and urodynamic study. The main urodynamic parameters (bladder capacity and bladder compliance) were assessed in the pre and postoperative moments, and compared by the Wilcoxon Signed Rank test. The main long-term complications were described. RESULTS 269 patients (mean age 14±13 years, 47% male) underwent BA with the use of demucolised intestinal segments. Among the patients in the sample, 187 (69.52%) had neurogenic bladder, 68 (25.28%) had bladder exstrophy, nine had tuberculosis (3.34%), four had a posterior urethral valve (1.49%) and one with hypospadia (0.37%). After the surgical procedure, a significant increment in both urodynamic parameters was found, with a 222% increase in bladder capacity and 604% in bladder compliance (p < 0.001 in both analyzes). Mean follow-up time ranged from 2 to 358 months, with a median of 72 months (IQR 74-247). Among all patients, 5 presented spontaneous perforation. CONCLUSION The study showed statistically signifi cant increase in both compliance and bladder capacity after non-secretory BA, with a low rate of severe complications.
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Affiliation(s)
- Rose A F Dantas
- Programa de Pós-Graduação em Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil
| | - Fernanda C F S Calisto
- Programa de Pós-Graduação em Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil
| | - Fabio O Vilar
- Departamento de Urologia, Hospital das Clínicas da Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil
| | - Luiz A P Araujo
- Departamento de Cirurgia Pediátrica, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil
| | - Salvador V C Lima
- Departamento de Cirurgia, Centro de Ciências da Saúde da Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil
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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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O'kelly F, Keefe D, Herschorn S, Lorenzo AJ. Contemporary issues relating to transitional care in bladder exstrophy. Can Urol Assoc J 2018; 12:S15-S23. [PMID: 29681269 DOI: 10.5489/cuaj.5313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Fardod O'kelly
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Daniel Keefe
- Division of Urology, The Ottawa Hospital, Ottawa, ON
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON; Canada
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Benz KS, Jayman J, Doersch K, Maruf M, Baumgartner T, Kasprenski M, Gearhart JP. Bladder Re-augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention. Urology 2018; 115:157-161. [PMID: 29447946 DOI: 10.1016/j.urology.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize the causes of re-augmentation in patients with classic bladder exstrophy (CBE). METHODS A prospectively maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for patients with CBE who underwent more than 1 augmentation cystoplasty (AC) procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated. RESULTS A total of 166 patients with CBE underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17 of 17), inadequate bladder necks (8 of 17), failed rattail augmentation (2 of 17), stomal incontinence (1 of 17), a urethrocutaneous fistula (1 of 17), and an hourglass augmentation (1 of 17). Of note, 5 of the 17 patients (29%) had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), whereas the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm (standard deviation [SD] 3.6) compared with 19 cm (SD 5.0) during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm (SD 4). The mean re-augmentation preoperative bladder capacity of 100 mL (SD 60) immediately increased after re-augmentation to 180.8 mL (SD 56.4) (P = .0001). CONCLUSION Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure.
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Affiliation(s)
- Karl S Benz
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - John Jayman
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Karen Doersch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD; Texas A&M Health Science Center College of Medicine, Temple, TX
| | - Mahir Maruf
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Timothy Baumgartner
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Matthew Kasprenski
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD.
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Abstract
Urinary diversion (UD) with an intestinal segment has significant risks of short- and long-term complications. With modern reporting criteria, understanding of the true prevalence and spectrum of these complications has improved. Methods to minimize early postoperative complications include enhanced recovery pathways, restricted intraoperative fluid protocols, and referral to high-volume centers. With long-term follow-up after UD, the risk of complications steadily rises. Late surgical complications include ureterointestinal anastomotic strictures, urolithiasis, and stomal issues. Patients with UDs require close surveillance to monitor for anatomic, infectious, and metabolic complications and surgeons who perform UD should be aware of the risk and timing of postoperative complications.
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Marien T, Robles J, Kammann TM, Kadihasanoglu M, Viprakasit DP, Herrell SD, Miller NL. Characterization of Urolithiasis in Patients Following Lower Urinary Tract Reconstruction with Intestinal Segments. J Endourol 2016; 31:217-222. [PMID: 27936931 DOI: 10.1089/end.2016.0297] [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: 11/13/2022] Open
Abstract
PURPOSE Urinary diversion and augmentation cystoplasty are associated with long-term complications, including metabolic derangements, infectious complications, and urolithiasis. The aim of this series was to characterize upper and lower urinary tract (LUT) calculi in this population. METHODS A retrospective chart review was performed on all patients with a history of urinary diversion or augmentation cystoplasty who subsequently underwent treatment for urolithiasis between January 1998 and May 2015. Data collected included demographics, perioperative characteristics, type of reconstructive procedure, urine culture, stone analysis, and metabolic evaluation. A statistical analysis was performed. RESULTS Ninety-nine patients were identified with a history of urolithiasis and incontinent urinary diversion (28), neobladder (21), continent cutaneous diversion (12), and augmentation cystoplasty (38). LUT stones were more common than upper tract stones in all except for incontinent diversions, which only had one lower tract stone (p = 0.0001). Twenty-three percent of stones were metabolic. Several metabolic derangements were noted, including hypocitraturia (100%), elevated urine pH (100%), low urine volume (70%), and hyperoxaluria (35%). There was a 44% rate of recurrent urolithiasis. CONCLUSIONS Given the high rate of stone recurrence among patients with a history of urinary diversion and augmentation cystoplasty, all measures should be taken to prevent recurrent stones. In addition to actions aimed to prevent infectious stones such as bladder and pouch irrigation, we recommend these patients undergo a full metabolic workup with targeted dietary changes and medical therapies.
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Affiliation(s)
- Tracy Marien
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Jennifer Robles
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Trisha M Kammann
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Mustafa Kadihasanoglu
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Davis P Viprakasit
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - S Duke Herrell
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Nicole L Miller
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
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Surgical and Metabolic Management of Urolithiasis Following Bladder Reconstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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26
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Doyle S, Carter B, Bray L, Sanders C. Bladder augmentation in children and young adults: a review of published literature. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2016. [DOI: 10.1111/ijun.12079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Doyle
- Alder Hey Children's NHS Foundation Trust and Lecturer; Edge Hill University; Liverpool UK
| | - Bernie Carter
- University of Central Lancashire & Alder Hey Children's NHS Foundation Trust; Preston & Liverpool UK
| | - Lucy Bray
- Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust and Evidence-based Practice Research Centre; Edge Hill University; Liverpool UK
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Urolithiasis following urinary diversion. Urolithiasis 2016; 44:383-8. [DOI: 10.1007/s00240-016-0880-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
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Szymanski KM, Misseri R, Whittam B, Lingeman JE, Amstutz S, Ring JD, Kaefer M, Rink RC, Cain MP. Bladder stones after bladder augmentation are not what they seem. J Pediatr Urol 2016; 12:98.e1-6. [PMID: 26455637 DOI: 10.1016/j.jpurol.2015.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 06/01/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bladder and renal calculi after bladder augmentation are thought to be primarily infectious, yet few studies have reported stone composition. OBJECTIVE The primary aim was to assess bladder stone composition after augmentation, and renal stone composition in those with subsequent nephrolithiasis. The exploratory secondary aim was to screen for possible risk factors for developing infectious stones. STUDY DESIGN Patients treated for bladder stones after bladder augmentation at the present institution between 1981 and 2012 were retrospectively reviewed. Data were collected on demographics, surgeries and stone composition. Patients without stone analysis were excluded. Stones containing struvite, carbonate apatite or ammonium acid ureate were classified as infectious. The following variables were analyzed for a possible association with infectious bladder stone composition: gender, history of cloacal exstrophy, ambulatory status, nephrolithiasis, recurrent urea-splitting urinary tract infections, first vs recurrent stones, timing of presentation with a calculus, history of bladder neck procedures, catheterizable channel and vesicoureteral reflux. Fisher's exact test was used for analysis. RESULTS Of the 107 patients with bladder stones after bladder augmentation, 85 met inclusion criteria. Median age at augmentation was 8.0 years (follow-up 10.8 years). Forty-four patients (51.8%) recurred (14 multiple recurrences, 143 bladder stones). Renal calculi developed in 19 (22.4%) patients with a bladder stone, and 10 (52.6%) recurred (30 renal stones). Overall, 30.8% of bladder stones were non-infectious (Table). Among patients recurring after an infectious bladder stone, 30.4% recurred with a non-infectious one. Among patients recurring after a non-infectious stone, 84.6% recurred with a non-infectious one (P = 0.005). Compared with bladder stones, renal stones were more likely to be non-infectious (60.0%, P = 0.003). Of patients with recurrent renal calculi after an infectious stone, 40.0% recurred with a non-infectious one. No clinical variables were significantly associated with infectious stone composition on univariate (≥0.28) or bivariate analysis (≥0.36). DISCUSSION This study had several limitations: it was not possible to accurately assess adherence with bladder irrigations, and routine metabolic evaluations were not performed. The findings may not apply to patients in all clinical settings. While stone analysis was available for 3/4 of the stones, similar rates of incomplete stone analyses have been reported in other series. CONCLUSIONS In patients with bladder augmentation, 1/3 of bladder stones and >1/2 of renal stones were non-infectious. Furthermore, an infectious stone does not imply an infectious recurrent stone and no known clinical variables appear to be associated with stone composition, suggesting that there is a possible metabolic component in stone formation after bladder augmentation.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - James E Lingeman
- Division of Urology, Indiana University Health Methodist Hospital, Methodist Professional Center 1, 1801 North Senate Blvd., Suite 220, Indianapolis, IN 46202, USA
| | - Sable Amstutz
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - Joshua D Ring
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
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Husmann DA. Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration. Transl Androl Urol 2016; 5:3-11. [PMID: 26904407 PMCID: PMC4739984 DOI: 10.3978/j.issn.2223-4683.2015.12.06] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures. METHODS We reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up. RESULTS The development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8-45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant with intermittent catheterization. The onset of upper tract deterioration (i.e., new scar formation, hydronephrosis, calculus development, decrease in renal function) was silent, that is, clinically asymptomatic in one third (10/32 pts). CONCLUSIONS This paper documents the need for high volume bladder irrigations to both prevent the most common complication following bladder augmentation, which is the development of bladder calculi and to reduce the incidence of symptomatic urinary tract infections. It provides a unique perspective regarding the impact of substance abuse and patient non-compliance with medical directives as being both the most common cause for both spontaneous bladder rupture following augmentation cystoplasty and for deterioration of the upper tracts. These findings should cause the surgeon to reflect on his/her assessment of a patient prior to performing a bladder augmentation procedure and stress the need for close follow-up.
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Ordon M, Andonian S, Blew B, Schuler T, Chew B, Pace KT. CUA Guideline: Management of ureteral calculi. Can Urol Assoc J 2015; 9:E837-51. [PMID: 26788233 DOI: 10.5489/cuaj.3483] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.
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Affiliation(s)
- Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University, Montreal, QC
| | - Brian Blew
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON
| | - Trevor Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
| | - Ben Chew
- Department of Urology, University of British Columbia, Vancouver, BC
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON
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Kisku S, Sen S, Karl S, Mathai J, Thomas RJ, Barla R. Bladder calculi in the augmented bladder: a follow-up study of 160 children and adolescents. J Pediatr Urol 2015; 11:66.e1-6. [PMID: 25819600 DOI: 10.1016/j.jpurol.2014.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bladder augmentation (BA) has been used for various congenital and acquired conditions to create a low pressure, continent catheterizable reservoir. The prevalence of calculi within the BA have been reported to be from 3 to 52.5%. The present study reports the prevalence and risk factors of bladder calculi in patients with BA. MATERIAL AND METHODS A retrospective review of 160 patients was performed from January 1997 through December 2012. The various risk factors for the formation of bladder calculi such as the nature of the anatomical defect, presence of preoperative urinary calculi, type of bowel augmentation, addition of a mitrofanoff and/or bladder neck procedure, prevalence of post-operative urinary tract infections (UTIs), need for mitrofanoff revision due to stenosis/difficulty catheterization, postoperative significant hydronephrosis and bladder calculi were recorded for analysis. The children underwent open removal or endoscopic cystolithotripsy. One hundred and eight males and 52 females (average age 6.3 years) were followed up for a median of 70.5 months. All patients performed daily bladder irrigation with tap or drinking water. RESULTS Post-operative bladder calculi were noted in 14 (8.8%) of 160 patients following BA. Median time to stone formation was 37.5 months (11-120 months). Recurrent febrile UTIs were noted in 16 of the 160 patients following BA. The various risk factors and their outcomes are summarized in table. Eight patients underwent open cystolithotomy and four patients were treated by cystolithotripsy. Post-operative recurrent bladder calculi were noted in 2 patients. Multivariate analysis revealed that exstrophy/epispadias (OR 17.2) and recurrent UTI (OR 55.4) were independent risk factors for developing postoperative calculi in bladder augmentations. All other risk factors did not achieve statistical significance. DISCUSSION There seemed to be no difference in the prevalence of calculi in the ileal or colonic augmentations. Mucus secreted by the bowel segment blocks catheters leading to incomplete drainage, stagnation and UTIs. Our protocol consists of daily bladder irrigation till the effluents are clear of mucus. This is probably the key to the low prevalence of postoperative calculi (8.8%) in our patients. CONCLUSION Bladder exstrophy/epispadias and UTIs are independent statistically significant risk factors for the formation of bladder calculi in BA patients. Other risk factors such as preoperative calculi, bladder neck procedures and the use of mitrofanoff though not statistically significant, may contribute to the overall risk. The performance of daily bladder irrigation is an important part of our management of mucus.
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Affiliation(s)
- S Kisku
- Department of Paediatric Surgery, Christian Medical College, Vellore 632004, India.
| | - S Sen
- Department of Paediatric Surgery, Christian Medical College, Vellore 632004, India
| | - S Karl
- Department of Paediatric Surgery, Christian Medical College, Vellore 632004, India
| | - J Mathai
- Department of Paediatric Surgery, Christian Medical College, Vellore 632004, India
| | - R J Thomas
- Department of Paediatric Surgery, Christian Medical College, Vellore 632004, India
| | - R Barla
- Department of Paediatric Surgery, Christian Medical College, Vellore 632004, India
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Merriman LS, Arlen AM, Kirsch AJ, Leong T, Smith EA. Does augmentation cystoplasty with continent reconstruction at a young age increase the risk of complications or secondary surgeries? J Pediatr Urol 2015; 11:41.e1-5. [PMID: 25725612 DOI: 10.1016/j.jpurol.2014.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE Lower urinary tract reconstruction with augmentation cystoplasty (AC) is an effective strategy for achieving urinary continence in children with neurogenic or severely compromised bladder. We compared complications and need for secondary surgeries in children 3-5 years of age undergoing AC with continent reconstruction to those ≥ 6 years old. STUDY DESIGN Medical charts of children undergoing AC with continent urinary diversion between 2003 and 2011 were reviewed. Complications and secondary surgeries were analyzed according to patient age. Patient demographics, etiology of bladder dysfunction, bowel segment used, and concomitant procedures were also assessed. RESULTS One hundred and eight children underwent AC with continent urinary diversion. Mean age at augmentation was 8.5 years (range 3-20). Twenty-eight children (25.9%) were 3-5 years old and 80 (74.1%) were ≥ 6 years. Mean follow-up was 6.93 years (range 1.6-10 years). Bowel segment used included ileum in 59 (54.6%), sigmoid in 33 (30.6%), cecum in 4 (3.7%) and composite in 12 (11.1%). Major complications included bowel obstruction in 6 (5.6%), bladder perforation in 3 (2.8%) and fistula in 2 (1.9%). There was no difference in major complications based on bowel segment utilized (p = 0.804, OR 0.894) or age (p = 0.946, OR 0.969). Fifty children (46.3%) required no additional surgeries; the remaining 58 underwent 137 procedures post-augmentation. Surgeries included urolithiasis management (58/137, 42.3%), appendicovesicostomy revision including stoma revision or redo for persistent leakage between catheterizations in (34/137, 24.8%), bladder neck procedures (26/137, 19%) and revision of MACE (19/137, 13.9%) [Figure]. Incidence of stones in patients 3-5 years (32.1%) was not significantly different than children ≥ 6 years of age (25%, p = 0.463, OR 0.704). Mean number of secondary surgeries for those 3-5 years was 1.21 ± 1.34, which was not statistically different than those ≥ 6 (1.3 ± 1.82, p = 0.154). Children with myelomeningocele (MMC) were statistically more likely to require secondary surgeries than those with other bladder pathology (p = 0.01). DISCUSSION Augmentation enterocystoplasty with cutaneous continent catheterizable channel is performed both to protect the upper urinary tract and afford the patient the option of social continence. Continent lower urinary tract reconstruction has been proven technically feasible and safe in preschool-aged children however, the ideal age for augmentation remains unknown. Urolithiasis accounted for over 40% of additional procedures in our series, with 26.9% of patients requiring one or more surgeries for stone disease. The incidence of stone disease in patients 3-5 years of age at the time of augmentation was comparable to that seen in older children. The overall need for additional post-augment procedures was not influenced by patient age or bowel segment utilized, however children with MMC were significantly more likely to require future surgeries than those with a different underlying etiology of bladder dysfunction. Our study has several limitations that warrant mention. Children with neurogenic bladder represent a heterogeneous population, and their surgical outcomes are inherently influenced by underlying disease processes and severity. Complications and secondary surgeries were assessed; however success rates were not evaluated in the current study. Patient and caregiver adherence with CIC and daily bladder irrigation was not assessed; whether noncompliance affected complication rates (i.e. stone formation) is unknown. CONCLUSION Whether performed at a young or older age, families must be adequately counseled regarding the daily management responsibilities and potential risks associated with lower urinary tract reconstruction including bladder augmentation. Augmentation with continent urinary diversion in selected patients 3-5 years of age confers complication and secondary surgery risk equal to that observed in their older counterparts.
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Affiliation(s)
- Laura S Merriman
- Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Angela M Arlen
- Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew J Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health and Emory University School of Medicine, Atlanta, GA, USA
| | - Edwin A Smith
- Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
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Schlomer BJ, Copp HL. Cumulative incidence of outcomes and urologic procedures after augmentation cystoplasty. J Pediatr Urol 2014; 10:1043-50. [PMID: 24766857 PMCID: PMC4195808 DOI: 10.1016/j.jpurol.2014.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Augmentation cystoplasty (AC) is a major surgery that can be associated with long-term morbidity. This study aimed to describe the cumulative incidence of outcomes and urologic procedures in a large cohort of children who underwent AC, identify significant sources of morbidity, and to evaluate baseline factors associated with outcomes of interest. METHODS Children≤18 years who underwent AC in the Pediatric Health Information System from 1999 to 2010 were included. All follow-up encounters up to June 2012 were included. Cumulative incidences for 15 outcomes and urologic procedures were calculated using non-informative censoring. Sensitivity analyses were performed to determine effect of censoring assumptions and including hospitals without complete datasets. As an exploratory analysis, baseline patient factors were evaluated for associations with outcomes and urologic procedures of interest using multivariable Cox proportional hazards models adjusted for clustering by hospital. RESULTS 2831 AC patients were identified. Based on cumulative incidence calculations and sensitivity analyses; the cumulative incidence ranges of outcomes and procedures at 1, 3, 5, and 10 years were calculated. Examples of 10-year cumulative incidence ranges are given for the following outcomes and procedures: bladder rupture (2.9-6.4%), small bowel obstruction (5.2-10.3%), bladder stones (13.3-36.0%), pyelonephritis (16.1-37.1%), cystolithopaxy (13.3-35.1%), and reaugmentation (5.2-13.4%). The development of chronic kidney disease was strongly associated with a diagnosis of lower urinary tract obstruction (HR 13.7; 95% CI 9.4-19.9). Bladder neck surgery and stoma creation at time of AC were associated with an increased hazard of bladder rupture (HR 1.9; 95% CI 1.1-3.3) and bladder stones (HR 1.4; 95% CI 1.1-1.8) respectively. CONCLUSIONS Outcomes of interest and urologic procedures after AC are common. Results from this large cohort can be used to counsel patients and families about expectations after AC. Pyelonephritis, chronic kidney disease, further reconstructive surgery, and calculus disease appear to cause significant morbidity. Collaborative efforts are needed to further reduce morbidity in this patient population.
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Affiliation(s)
- Bruce J Schlomer
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin, MC CCC-620, Houston, TX 77030, USA.
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Degener S, Roth S, Mathers MJ, Ubrig B. [Follow-up care - consequences of urinary diversion after bladder cancer]. Urologe A 2014; 53:253-62; quiz 263-4. [PMID: 24477880 DOI: 10.1007/s00120-013-3376-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Radical cystectomy is the standard of care for muscle-invasive bladder cancer. Continent urinary diversions utilizing both small and large bowel are becoming more prominent: therefore, the postoperative follow-up has to focus on different aspects. In the first instance after radical cystectomy functional issues with respect to potential stenosis, post-void residual urine and micturition disorders are important. In the early phase the oncological follow-up aims to detect local, urethral and systemic recurrences and new data show the importance of the first 3 years after surgery. Long-term follow-up focuses on metabolic aspects, such as cobalamin or bile acid deficits, acidosis and disorders of calcium and bone metabolism. Follow-up care should consider specific complications of different types of urinary diversions; however to date standardized follow-up guidelines are lacking.
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Affiliation(s)
- S Degener
- Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM), Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland,
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Avallone MA, Prince MK, Guralnick ML, O’Connor RC. Long-Term Enterocystoplasty Follow-Up: Metabolic and Neoplastic Concerns. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0266-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Arlen AM, Merriman LS, Elmore JM, Smith EA, Kirsch AJ. Rapid construction of sigmoid bladder augmentation using absorbable staples: long-term results and comparison to standard colocystoplasty in children with neurogenic bladder. J Pediatr Urol 2014; 10:284-8. [PMID: 24210914 DOI: 10.1016/j.jpurol.2013.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Absorbable staples facilitate detubularization and reconfiguration of the bowel when performing augmentation colocystoplasty. We compared the outcomes of stapled sigmoid augmentation with standard sutured colocystoplasty. MATERIALS AND METHODS Between 2003 and 2011, 108 children underwent bladder augmentation at our institution. Colocystoplasty was used in 30 patients (27.8%). Medical charts of children who underwent stapled (n = 8) or sutured (n = 22) sigmoid augmentation were compared with regard to patient demographics and surgical complications, including anastomotic leak and urolithiasis. RESULTS Eight children with underwent stapled sigmoid colocystoplasty. Average age at surgery was 8 years (range 4-17 years). Time to detubularize and refashion the bowel segment prior to augmentation was consistently under 5 min. Average length of follow-up was 44 months (range 12-80 months). One patient experienced anastomotic leak. Two of eight children (25%) in the stapled anastomosis cohort developed bladder stones. Twenty-two patients underwent standard sigmoid augmentation during the same time period (average age 8.2 years; range 4-16 years). One of 22 (4.5%) experienced anastomotic leak. Seven of 22 (31.8%) developed cystolithiasis. CONCLUSIONS Complications from stapled sigmoid anastomosis are similar to those from standard colocystoplasty. Use of absorbable staples decreases operating time by avoiding bowel spatulation and suturing, and should be considered in pediatric patients undergoing colocystoplasty.
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Affiliation(s)
- Angela M Arlen
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Laura S Merriman
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - James M Elmore
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Edwin A Smith
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew J Kirsch
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Affiliation(s)
- Albert Tiu
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kaplan AG, Ghoniem GM. Long-Term Outcomes of Augmentation Enterocystoplasty with a Catheterizable Channel in the Adult Neurogenic Population. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0210-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Urolithiasis in adult spina bifida patients: study in 260 patients and discussion of the literature. Int Urol Nephrol 2013; 45:695-702. [DOI: 10.1007/s11255-013-0445-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022]
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Sigmoidocolocystoplasty with ureteral reimplantation for treatment of neurogenic bladder. Urology 2012; 80:440-5. [PMID: 22857763 DOI: 10.1016/j.urology.2012.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/04/2012] [Accepted: 05/07/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the clinical and urodynamic results of sigmoidocolocystoplasty in patients with neurogenic bladder dysfunction. METHODS We retrospectively reviewed 78 augmentation enterocystoplasty cases in our database from 2005 to 2011 to identify 47 patients who had undergone sigmoidocolocystoplasty alone or combined with ureter reimplantation. The indications for surgery and postoperative complications were evaluated. Renal function preservation, increased postoperative bladder capacity, decreased maximal detrusor pressure, and overall patient satisfaction were deemed successful outcomes. RESULTS The mean follow-up period was 24 months. The mean bladder capacity increased from 160.6 ± 128.3 to 468.5 ± 60.6 mL (P < .001) and the maximal detrusor pressure decreased from 31.1 ± 26.4 to 10.9 ± 4.5 cm H(2)O (P = .002). The serum creatinine level decreased from 270.3 ± 113.6 to 174.4 ± 81.3 μmol/L (P = .001). Most patients resolved the urinary incontinence using clean self-intermittent catheterization. The decrease in the mean number of incontinence episodes and pads used daily indicated a marked improvement in patients' quality of life. Postoperative complications included bowel dysfunction in 5 patients (10.6%), adhesive intestinal obstruction in 4 (8.5%), deteriorating renal function in 3 (6.4%), and vesicoureteral reflux recurrence in 2 patients (4.3%). Nearly all patients expressed satisfaction with the urologic management. CONCLUSION Our results suggest that sigmoidocolocystoplasty is safe and effective in treating patients with neurogenic bladder dysfunction. Concomitant ureter reimplantation will be beneficial for patients with a long history of illness.
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Augmentation cystoplasty: diagnosis, treatment and outcome. Eur Surg 2012. [DOI: 10.1007/s10353-012-0106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int 2011; 109:1280-93. [PMID: 22117733 DOI: 10.1111/j.1464-410x.2011.10650.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
What's known on the subject? And what does the study add? There is a wealth of evidence on the development, indications, outcomes and complications of augmentation cystoplasty (AC). Over the last decade, new evidence has been emerging to influence our clinical practice and application of this technique. AC is indicated as part of the treatment pathway for both neurogenic and idiopathic detrusor overactivity, usually where other interventions have failed or are inappropriate. The most commonly used technique remains augmentation with a detubularised patch of ileum (ileocystoplasty). Controversy persists over the role of routine surveillance following ileocystoplasty for the detection of subsequent bladder carcinoma; however the indication for surveillance after gastrocystoplasty is clearer due to a rising incidence of malignancy in this group. Despite a reduction in the overall numbers of AC operations being performed, it clearly still has a role to play, which we re-examine with contemporary studies from the last decade.
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Affiliation(s)
- Suzanne M Biers
- Department of Urology, Leicester General Hospital, Leicester, UK.
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Gurocak S, Nuininga J, Ure I, De Gier RPE, Tan MO, Feitz W. Bladder augmentation: Review of the literature and recent advances. Indian J Urol 2011; 23:452-7. [PMID: 19718303 PMCID: PMC2721579 DOI: 10.4103/0970-1591.36721] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Bladder augmentation is an important tool in the management of children requiring reconstructions for urinary incontinence or preserving of the upper urinary tract in congenital malformations. We reviewed the literature and evaluated the long-term results of enterocystoplasty in the pediatric age group and summarized techniques, experimental options and future perspectives for the treatment of these patients. For this purpose, a directed Medline literature review for the assessment of enterocystoplasty was performed. Information gained from these data was reviewed and new perspectives were summarized. The ideal gastrointestinal (GI) segment for enterocystoplasty remains controversial. The use of GI segments for enterocystoplasty is associated with different short and long-term complications. The results of different centers reported in the literature concerning urological complications after enterocystoplasty are difficult to compare because of the non-comparable aspects and different items included by different authors. On the other hand, there are more and more case reports about cancer arising from bowel segments used for bladder augmentation in recent publications. Although bladder reconstruction with GI segments can be associated with multiple complications, such as metabolic disorders, calculus formation, mucus production, enteric fistulas and potential for malignancy, enterocystoplasty is unfortunately still the gold standard. However, there is an urgent need for the development of alternative tissues for bladder augmentation.
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Affiliation(s)
- Serhat Gurocak
- Gazi University School of Medicine, Department of Urology, Section of Pediatric Urology, Ankara, Turkey
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Bladder Augmentation Versus Urinary Diversion in Patients With Spina Bifida in the United States. J Urol 2011; 186:161-5. [DOI: 10.1016/j.juro.2011.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Indexed: 11/23/2022]
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van den Heijkant M, Haider N, Taylor C, Subramaniam R. Efficacy of bladder irrigation and surveillance program in prevention of urinary tract infections and bladder calculi in children with an ileocystoplasty and bladder neck repair. Pediatr Surg Int 2011; 27:781-5. [PMID: 21553274 DOI: 10.1007/s00383-011-2913-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE In children with bladder augmentation and particularly in those with bladder neck repair (BNR), urinary tract infections (UTI) and bladder calculi are a recognised problem. Bladder irrigation potentially prevents these complications. Our aim was to investigate the efficacy of bladder irrigation supported by a surveillance program in prevention of UTI and bladder calculi in these children. METHODS A cohort of children subjected to ileocystoplasty with a stoma for clean intermittent self catheterisation with or without BNR was retrospectively analysed. The children were subjected to bladder irrigation and monitored by Clinical Nurse Specialists (CNS) according to a protocol. Patients' demographics, treatment methods and postoperative management were reviewed. Compliance to bladder irrigation was assessed with questionnaires. UTI recurrence and bladder calculi during follow-up were assessed. RESULTS 28 children were included in this study. The median follow-up was 48 months (range 6-87). Compliance could be assessed in all children, except in one child (3.5%). There was no recurrent UTI reported, bladder calculi occurred in two children (7%). CONCLUSION Our bladder irrigation regime resulted in a low incidence of calculi by preventing recurrent UTI. The surveillance program resulted in high compliance rates in children with an augmented bladder with or without BNR.
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Okhunov Z, Duty B, Smith AD, Okeke Z. Management of urolithiasis in patients after urinary diversions. BJU Int 2011; 108:330-6. [DOI: 10.1111/j.1464-410x.2011.10194.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kispal Z, Balogh D, Erdei O, Kehl D, Juhasz Z, Vastyan AM, Farkas A, Pinter AB, Vajda P. Complications after bladder augmentation or substitution in children: a prospective study of 86 patients. BJU Int 2010; 108:282-9. [PMID: 21070584 DOI: 10.1111/j.1464-410x.2010.09862.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To evaluate complications after urinary bladder augmentation or substitution in a prospective study in children. PATIENTS AND METHODS • Data of 86 patients who underwent urinary bladder augmentation (80 patients) or substitution (6 patients) between 1988 and 2008 at the authors' institute were analysed. • Ileocystoplasty occurred in 32, colocystoplasty in 30 and gastrocystoplasty in 18. Urinary bladder substitution using the large bowel was performed in six patients. • All patients empty their bladder by intermittent clean catheterization (ICC), 30 patients via their native urethra and 56 patients through continent abdominal stoma. Mean follow-up was 8.6 years. • Rate of complications and frequency of surgical interventions were statistically analysed (two samples t-test for proportions) according to the type of gastrointestinal part used. RESULTS • In all, 30 patients had no complications. In 56 patients, there were a total of 105 complications (39 bladder stones, 16 stoma complications, 11 bowel obstructions, 5 reservoir perforations, 7 VUR recurrences, 1 ureteral obstruction, 4 vesico-urethral fistulae, 4 orchido-epididymitis, 4 haematuria-dysuria syndrome, 3 decreased bladder capacity/compliance, 3 pre-malignant histological changes, 1 small bowel bacterial overgrowth and 7 miscellaneous). • In 25 patients, more than one complication occurred and required 91 subsequent surgical interventions. Patients with colocystoplasty had significantly more complications (P < 0.05), especially more stone formation rate (P < 0.001) and required more post- operative interventions (P < 0.05) than patients with gastrocystoplasty and ileocystoplasty. CONCLUSIONS • Urinary bladder augmentation or substitution is associated with a large number of complications, particularly after colocystoplasty. • Careful patient selection, adequate preoperative information and life-long follow-up are essential for reduction, early detection and management of surgical and metabolic complications in patients with bladder augmentation or substitution.
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Affiliation(s)
- Zoltan Kispal
- Department of Pediatrics, Surgical Unit, University of Pecs, Pecs, Hungary.
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Watanabe JH, Campbell JD, Ravelo A, Chancellor MB, Kowalski J, Sullivan SD. Cost Analysis of Interventions for Antimuscarinic Refractory Patients With Overactive Bladder. Urology 2010; 76:835-40. [DOI: 10.1016/j.urology.2010.01.080] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 01/09/2010] [Accepted: 01/18/2010] [Indexed: 11/24/2022]
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Spahn M, Kocot A, Loeser A, Kneitz B, Riedmiller H. Last Resort in Devastated Bladder Outlet: Bladder Neck Closure and Continent Vesicostomy—Long-term Results and Comparison of Different Techniques. Urology 2010; 75:1185-92. [DOI: 10.1016/j.urology.2009.11.070] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 11/18/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
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