title: Long-term renal functional outcomes after primary gastrocystoplasty.
abstract: OBJECTIVE
  We assessed long-term renal function, morbidities and mortality in 50 patients who had undergone primary gastrocystoplasty at our institution.
  
  
  METHODS
  We retrospectively reviewed patients 21 years or younger who had undergone primary gastrocystoplasty between 1984 and 2004. Patients who underwent secondary gastrocystoplasty or primary composite augmentation or had cloacal exstrophy were excluded. Primary outcome was progression to end-stage renal disease. Secondary outcomes included mortality, bladder malignancy, hematuria-dysuria syndrome, electrolyte abnormalities and surgical revisions.
  
  
  RESULTS
  Of 50 patients who had undergone gastrocystoplasty 35 met inclusion criteria. Median age was 9.4 years and 60% of the patients were male. Median followup was 19 years (IQR 11 to 25). Of the 35 patients 15 (43%) had normal preoperative estimated glomerular filtration rate and 5 (14%) had stage 2, 10 (29%) stage 3 and 5 (14%) stage 4 chronic kidney disease. Five of the 15 patients with stage 3 or 4 chronic kidney disease improved to normal estimated glomerular filtration rate, 1 remained with stage 3 disease and 9 progressed to end-stage renal disease. In 1 patient with normal estimated glomerular filtration rate end-stage renal disease developed following an episode of septic shock due to osteomyelitis. Seven patients in the cohort (20%) died, with 1 each dying of ventriculoperitoneal shunt infection, pneumonia, end-stage renal disease, complications of pregnancy and unknown cause, and 2 patients dying of septic shock due to urinary tract infection. There were no bladder malignancies. Hematuria-dysuria syndrome developed in 9 patients (24%). Eight patients (23%) underwent surgical revision.
  
  
  CONCLUSIONS
  The majority of patients had preserved or improved renal function after gastrocystoplasty. There were no deaths attributable to gastric augmentation and no bladder malignancies. Approximately a fourth of patients required surgical revision.
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: kchubert@iupui.edu.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Hubert
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Timothy
authors.initials: T
authors.lastname: Large
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Leiser
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Judge
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Konrad
authors.initials: K
authors.lastname: Szymanski
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Whittam
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Martin
authors.initials: M
authors.lastname: Kaefer
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Misseri
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Richard
authors.initials: R
authors.lastname: Rink
authors.affiliation: Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cain
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D013270:Stomach / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*
keywords: follow-up studies; pediatrics; renal insufficiency; urologic surgical procedures