Complications after bladder augmentation or substitution in children: a prospective study of 86 patients.
OBJECTIVE
• To evaluate complications after urinary bladder augmentation or substitution in a prospective study in children.


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.
Department of Pediatrics, Surgical Unit, University of Pecs, Pecs, Hungary. zachary22@gmail.com
Zoltan
Z
Kispal
Daniel
D
Balogh
Orsolya
O
Erdei
Daniel
D
Kehl
Zsolt
Z
Juhasz
Attila M
AM
Vastyan
Andras
A
Farkas
Andras B
AB
Pinter
Peter
P
Vajda
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D006801:Humans; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D001743:Urinary Bladder / Q000601:surgery*; D014546:Urinary Catheterization; D014547:Urinary Diversion / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000601:surgery*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*; D055815:Young Adult