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Decreased linear growth associated with intestinal bladder augmentation in children with bladder exstrophy
D A Gros1, J L Dodson, U A Lopatin
1Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Insights
Enterocystoplasty, a type of intestinal bladder augmentation, is linked to significant growth impediment in patients with bladder exstrophy. Further research is needed to find ways to prevent this common side effect.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Bladder exstrophy is a congenital condition requiring complex surgical reconstruction.
- Enterocystoplasty is a common surgical technique used to augment bladder capacity and improve continence in patients with bladder exstrophy.
Purpose of the Study:
- To investigate the impact of enterocystoplasty on linear growth in patients with bladder exstrophy.
- To compare growth patterns in patients who underwent intestinal bladder augmentation with those who did not.
Main Methods:
- A case-controlled study was conducted with 50 patients undergoing enterocystoplasty and 50 matched controls with nonaugmented bladder exstrophy.
- Growth charts were analyzed for 17 augmented and 15 nonaugmented patients with at least one pre- and post-operative height measurement.
Main Results:
- 82% of augmented patients (14/17) experienced a significant decrease in percentile height post-surgery (mean loss of 15.6 percentile points).
- Delayed growth occurred in 33% of controls (5/15) after age 7.7 years, but the overall group showed average growth.
- The mean age at surgery was 7.7 years, with follow-up periods of 5.7 and 7.3 years for augmented and control groups, respectively.
Conclusions:
- Intestinal bladder augmentation is strongly associated with a near-universal reduction in percentile height.
- Long-term monitoring and investigation into metabolic changes are crucial for developing strategies to mitigate growth impairment.
Purpose:
We determine if enterocystoplasty results in delayed linear growth using a case controlled study to observe the effects of intestinal bladder augmentation on growth in patients with bladder exstrophy.
Materials And Methods:
A total of 50 patients who had undergone bladder augmentation for incontinence due to classic bladder exstrophy were selected from our patient database and matched for gender, age and type of exstrophy with 50 patients who had nonaugmented bladder exstrophy. Patients were then contacted and asked to permit the pediatricians to release growth charts. Once consent was obtained the charts were requested from the pediatricians, and evaluable data, defined as at least 1 height before and after augmentation, were obtained for 17 of 50 (34%) augmented and 15 of 50 (30%) nonaugmented cases.
Results:
Mean age at surgery was 7.7 years. Delayed growth as defined by a postoperative decrease in percentile height occurred in 14 of 17 (82%) augmented cases (mean loss 15.6 percentile points). Delayed growth after age 7.7 years occurred in 5 of 15 (33%) controls but average growth for the entire group was 6.7 percentile points (p = 0. 014). Mean followup was 5.7 years (median 4.9) for the augmented group and 7.3 years (median 8.2) for the control group.
Conclusions:
Intestinal bladder augmentation is associated with a nearly universal decrease in percentile height. Close long-term followup of these patients and analysis of subtle metabolic alterations may provide information to help minimize or prevent growth impediment in the future.