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Pediatric urinary tract reconstruction using intestine
C Clementson Kockum1, I Helin, L Malmberg
1Department of Pediatric Surgery, University Hospital, Lund, Sweden.
Insights
Pediatric urinary tract reconstruction effectively achieves urinary continence and resolves reflux. Long-term monitoring is crucial to manage potential risks to renal and glomerular function, emphasizing bladder irrigation to prevent infections.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Pediatric Nephrology
Background:
- Urinary tract reconstruction addresses complex conditions like bladder exstrophy and neurogenic bladder in children.
- Established follow-up protocols are essential for evaluating surgical outcomes and long-term patient health.
Purpose of the Study:
- To analyze the outcomes of urinary tract reconstruction in pediatric patients.
- To assess continence, renal function, and potential complications following reconstructive surgery.
Main Methods:
- A cohort of 15 children (ages 4-18) with bladder exstrophy or neurogenic bladder underwent bladder augmentation or continent urinary reservoir procedures.
- Patients were followed for 1.7-6.3 years (median 3.7 years) with a predetermined monitoring program.
Main Results:
- High rates of continence were achieved, with significant resolution of vesicoureteral reflux.
- Renal function remained stable in most patients, though some experienced glomerular impairment and acidosis.
- Growth and bone mineral density were generally unaffected, but progressive parenchymal lesions were noted in cases with infections and calculi.
Conclusions:
- Urinary tract reconstruction in children leads to continence and reflux regression.
- While initial renal function and growth appear preserved, vigilant monitoring for glomerular function and metabolic complications is necessary.
- Regular bladder irrigation is vital to minimize urinary tract infection risk.
Objective:
To analyse the outcome of urinary tract reconstruction in children.
Material And Methods:
Fifteen children with bladder exstrophy or neurogenic bladder, 4-18 years old, were followed in accordance with a predetermined program for bladder augmentation (13 pat) or continent urinary reservoir (2 pat). The follow-up time was 1.7-6.3 years, median 3.7 years.
Results:
All were dry, though one case had occasional leaks. Three bladder neck reconstructions, two artificial sphincters, one sling plasty and one fistula closure with subsequent bladder neck injection were required. Bladder volumes were adequate for age at low pressures. Reflux resolved in 12/13 ureters. A boy with preoperative renal insufficiency was transplanted. Total renal function remained otherwise stable despite acidosis in one case and some glomerular impairment in all. Progressive parenchymal lesions were seen in combination with abundant mucus, infections and calculi only. Growth and bowel function was unaffected. Bone mineral density showed overall increase; some low values were not consistent between investigations.
Conclusions:
Urinary tract reconstruction in children results in continence and regression of reflux. Growth, bone mineralization and renal function are unimpaired during the first years, but irrigation of the bladder is essential to minimize the risk of urinary tract infection. However, glomerular function might be affected and the possible risk of metabolic complications in later life can only be determined by continuous close monitoring over an extended period of time.
Abbreviations:
Voiding cystourethrogram (VCUG), dimercapto-succinic acid (DMSA), Chrome51-Ethylenediaminetetraacetic acid (Cr-EDTA), single photon absorption (SPA), bone mineral content (BMC), bone mineral density (BMD), dual photon x-ray absorption (DEXA), glomerular filtration rate (GFR), urinary tract infection (UTI), immunoglobulin G (IgG), clean intermittent catheterization (CIC) and subureteral teflon injection (STING).