title: Urologic complications of major genitourinary reconstruction in the exstrophy-epispadias complex.
abstract: OBJECTIVE
  To present the authors' experiences with urologic complications associated with various techniques used to create a continent stoma (CS), augmentation cystoplasty (AC), and neobladder in the exstrophy-epispadias complex (EEC) population.
  
  
  METHODS
  Retrospective review of medical records of patients who underwent CS with or without bladder augmentation were identified from an institutional review board-approved database of 1208 EEC patients. Surgical indications, tissue type, length of hospital stay, age, preoperative bladder capacity, prior genitourinary surgeries, postoperative urological complications, and continence status were reviewed.
  
  
  RESULTS
  Among the EEC patients reviewed, 133 underwent CS (80 male, 53 female). Mean follow-up time after initial continent stoma was 5.31 years (range: 6 months to 20 years). Appendix and tapered ileum were the primary bowel segments used for the continent channel and stoma in the EEC population. The most common stomal complications in this population were stenosis, incontinence, and prolapse. Seventy-nine percent of EEC CS patients underwent AC primarily done with sigmoid colon or ileum. Eleven patients (8%) underwent neobladder creation with either colon or a combination of colon and ileum. Bladder calculi, vesicocutaneous fistula, and pyelonephritis were the most common non-stomal complications. Stomal ischemia was significantly increased in Monti ileovesicostomy compared to Mitrofanoff appendicovesicostomy in classic bladder exstrophy patients (p = 0.036). Furthermore, pyelonephritis was more than twice as likely in colonic neobladder than all other reservoir tissue types in the same cohort (OR = 2.53, 95% CI: 1.762-3.301, p < 0.001).
  
  
  CONCLUSIONS
  To the best of the authors' knowledge, this is the largest study examining catheterizable stomas in the exstrophy population. While Mitrofanoff appendicovesicostomy is preferred to Monti ileovesicostomy because it is technically less challenging, it may also confer a lower rate of stomal ischemia. Furthermore, even though ileum or colon can be used in AC with equally low complication rates, practitioners must be wary of potential urologic complications that should be primarily managed by an experienced reconstructive surgeon.
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Inouye
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Bhavik B
authors.initials: BB
authors.lastname: Shah
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Eric Z
authors.initials: EZ
authors.lastname: Massanyi
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Di Carlo
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kern
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Tourchi
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.affiliation: Division of Pediatric Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Stewart
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jgearhart@jhmi.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery; D003559:Cystostomy / Q000009:adverse effects*; D004842:Epispadias / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*; D055815:Young Adult
keywords: Complications; Continent urinary diversion; Exstrophy–epispadias complex; Genitourinary reconstruction