Comparison of long term outcomes after ileal and gastric bladder augmentation
Authors:
Radim Skalka 1,2; Radim Kočvara 1; Zdeněk Dítě 1; Jan Dvořáček 1; Tomáš Hanuš 1
Authors‘ workplace:
Urologická klinika 1. LF UK a VFN, Praha
1; Urologické oddělení FN, Ostrava
2
Published in:
Ces Urol 2013; 17(2): 109-117
Category:
Original article
Overview
Aim:
A comparison of long term outcomes in patients after gastrocystoplasty and ileocystoplasty and a comprehensive literature review to determine the risk of developing malignancy.
Material and method:
Between February 1990 and September 2006, 35 patients underwent 37 bladder augmentations. We compare the long-term outcome and overall morbidity of 17 patients after ileocystoplasty (ICPL) and 15 patients after gastrocystoplasty (GCPL). In the ICPL group, the median patient age at time of surgery was 12.5 years (5.8–19.2); primary diagnosis included neurogenic bladder and exstrophy/epispadia complex. In the GCPL group, the median age at time of surgery was 12.9 years (0.8–28.1); primary diagnosis was neurogenic bladder and exstrophy/epispadia complex. We retrospectively evaluated medical findings of the patients focusing on complications and long-term functional outcomes.
Results:
In the ICPL group, the mean follow-up time was 15.2 years. The mean cystometric bladder capacity increased from 122 to 401 mL and the mean maximum intravesical filling pressure decreased from 59.4 to 30cm of water. Complete urinary continence was achieved in 64.7% of patients. In the GCPL group, the mean follow-up time was 16.3 years. The mean cystometric bladder capacity increased from 121 to 327mL and the mean maximum intravesical filling pressure decreased from 65.4 to 33.7cm of water. Full urinary continence was achieved in 60% of patients. The rate of febrile UTIs was 11.7% after ICPL and 20% after GCPL. Bladder stones developed in 11.7% patients after ICPL. Twenty percent of patients in the GCPL group had hematuria – dysuria syndrome. We also report on our original therapeutic experience using potassium citrate. One patient in each group required reaugmentation with a different segment of the gastrointestinal tract. One patient from the GCPL group died due to renal failure. No malignant bladder tumors were detected during the follow-up period.
Conclusions:
Long-term outcome of ICPL and GCPL are comparable. We have achieved satisfactory functional results despite significant morbidity which was slightly higher in the GCPL group. Patients require regular surveillance and long-term follow-up in order to protect renal function and maintain acceptable urinary continence. Due to the risk of malignancy in the augmented bladder, annual cystoscopy has been recommended starting at 10 years after augmentation. Urologists, who take care of these patients in adulthood, should follow this recommendation.
Key words:
bladder tumors, exstrophy/epispadia complex, gastrocystoplasty, ileocystoplasty, neurogenic bladder.
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Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2013 Issue 2
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