Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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. Conclusions: 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.
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. Conclusions: 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.
참고문헌 (34)
- Adams MC, "Campbell-Walsh urology", pp.3656~3702 (2007), Saunders
- Keenan A, "Long-term outcomes following bladder augmentation in children with neurogenic bladder", Curr Bladder Dysfunct Rep, 9, pp.275~281 (2014)
- Surer I, "Continent urinary diversion and the exstrophy-epispadias complex", J Urol, 169, pp.1102~1105 (2003)
- Scales CD Jr, "Evaluating outcomes of enterocystoplasty in patients with spina bifida: a review of the literature", J Urol, 180, pp.2323~2329 (2008)
- Hayashi Y, "Review of 86 patients with myelodysplasia and neurogenic bladder who underwent sigmoidocolocystoplasty and were followed more than 10 years", J Urol, 176(4 Pt 2), pp.1806~1809 (2006)
- Austin JC, "Long-term risks of bladder augmentation in pediatric patients", Curr Opin Urol, 18, pp.408~412 (2008)
- Husmann DA, "Long-term follow up of enteric bladder augmentations: the risk for malignancy", J Pediatr Urol, 4, pp.381~385 (2008)
- Schaefer M, "Bladder augmentation with small intestinal submucosa leads to unsatisfactory long-term results", J Pediatr Urol, 9(6 Pt A), pp.878~883 (2013)
- Feng AH, "Influence of enterocystoplasty on linear growth in children with exstrophy", J Urol, 167, pp.2552~2555 (2002)
- Gros DA, "Decreased linear growth associated with intestinal bladder augmentation in children with bladder exstrophy", J Urol, 164(3 Pt 2), pp.917~920 (2000)
- Ragavan M, "Exstrophy bladder: effect of sigmoid colocystoplasty on physical growth and bone mineral density", J Indian Assoc Pediatr Surg, 16, pp.45~49 (2011)
- Gerharz EW, "Enterocystoplasty in childhood: a second look at the effect on growth", BJU Int, 91, pp.79~83 (2003)
- Soergel TM, "Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder", J Urol, 172(4 Pt 2), pp.1649~1651 (2004)
- Higuchi TT, "Augmentation cystoplasty and risk of neoplasia: fact, fiction and controversy", J Urol, 184, pp.2492~2496 (2010)
- Mundy AR, "“Clam” ileocystoplasty for the treatment of refractory urge incontinence", Br J Urol, 57, pp.641~646 (1985)
- Obermayr F, "Outcome of augmentation cystoplasty and bladder substitution in a pediatric age group", Eur J Pediatr Surg, 21, pp.116~119 (2011)
- Dykes EH, "The use of the Mitrofanoff principle in achieving clean intermittent catheterisation and urinary continence in children", J Pediatr Surg, 26, pp.535~538 (1991)
- Kari J, "Is mitrofanoff a more socially accepted clean intermittent catheterization (CIC) route for children and their families?", Eur J Pediatr Surg, 23, pp.405~410 (2013)
- Fontaine E, "The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up", BJU Int, 86, pp.195~198 (2000)
- Mehmood S, "Factors predicting renal function outcome after augmentation cystoplasty", Int J Nephrol, pp.3929352~ (2017)
- Biers SM, "The past, present and future of augmentation cystoplasty", BJU Int, 109, pp.1280~1293 (2012)
- DeFoor W, "Bladder calculi after augmentation cystoplasty: risk factors and prevention strategies", J Urol, 172(5 Pt 1), pp.1964~1966 (2004)
- Khoury AE, "Stone formation after augmentation cystoplasty: the role of intestinal mucus", J Urol, 158(3 Pt 2), pp.1133~1137 (1997)
- Hensle TW, "Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion:the influence of an irrigation protocol", BJU Int, 93, pp.585~587 (2004)
- Szymanski KM, "Bladder stones after bladder augmentation are not what they seem", J Pediatr Urol, 12, pp.98.e1~98.e6 (2016)
- Abeş M, "Evaluation of bone mineral density with dual x-ray absorptiometry for osteoporosis in children with bladder augmentation", J Pediatr Surg, 38, pp.230~232 (2003)
- Mundy AR, "Calcium balance, growth and skeletal mineralisation in patients with cystoplasties", Br J Urol, 69, pp.257~259 (1992)
- Mingin GC, "Growth and metabolic consequences of bladder augmentation in children with myelomeningocele and bladder exstrophy", Pediatrics, 110, pp.1193~1198 (2002)
- Hafez AT, "Long-term evaluation of metabolic profile and bone mineral density after ileocystoplasty in children", J Urol, 170(4 Pt 2), pp.1639~1641 (2003)
- DeFoor W, "Risk factors for spontaneous bladder perforation after augmentation cystoplasty", Urology, 62, pp.737~741 (2003)
- Metcalfe PD, "Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk", J Urol, 175, pp.1466~1470 (2006)
- Austin JC, "Patients with spina bifida and bladder cancer: atypical presentation, advanced stage and poor survival", J Urol, 178(3 Pt 1), pp.798~801 (2007)
- Drake MJ, "Incontinence", pp.827~954 (2013), ICUD-EAU
- López Pereira P, "Are urodynamic studies really needed during bladder augmentation follow-up?", J Pediatr Urol, 5, pp.30~33 (2009)