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Bladder functional outcome after delayed vesicostomy closure and antireflux surgery in young infants with 'primary'
M L Podesta1, A Ruarte, M Herrera
1The Urology Unit, Department of Surgery, Hospital de Ninos 'Ricardo Gutierrez', Buenos Aires, Argentina.
Insights
Temporary vesicostomy followed by antireflux surgery effectively restored bladder function in infants with primary vesicoureteric reflux (VUR). Urodynamic studies confirmed normal bladder function after re-establishing the lower urinary tract.
Area of Science:
- Pediatric Urology
- Urodynamics
- Pediatric Nephrology
Background:
- Primary vesicoureteric reflux (VUR) in infants often necessitates surgical intervention.
- Temporary cutaneous vesicostomy is a management option to protect renal function.
- Assessing long-term bladder function after vesicostomy closure and antireflux surgery is crucial.
Purpose of the Study:
- To evaluate bladder function using urodynamic investigations.
- To assess outcomes in young infants with primary VUR treated with temporary vesicostomy, antireflux surgery, and vesicostomy closure.
Main Methods:
- Nine male infants with primary VUR underwent initial vesicostomy, followed by delayed vesicostomy closure and antireflux surgery.
- Urodynamic assessment, including rapid-fill cystometry, was performed after vesicostomy closure.
- Long-term follow-up data on bladder function and continence were collected.
Main Results:
- Most VUR cases were successfully treated with ureteroneocystostomy or resolved spontaneously.
- Post-re-functionalization, bladder capacity was generally normal for age, with some variations.
- Detrusor pressures and compliance were mostly within normal limits, with a few exceptions of detrusor instability and low compliance.
Conclusions:
- Temporary vesicostomy followed by antireflux surgery and vesicostomy closure is a viable approach for managing VUR in infants.
- The bladder demonstrates normal functional recovery after re-establishment of the lower urinary tract.
- Long-term urodynamic assessment supports the efficacy of this treatment strategy.
Objective:
To evaluate bladder function by conventional urodynamic investigations in young infants with primary vesico-ureteric reflux (VUR) who had undergone an initial temporary cutaneous vesicostomy followed by later antireflux surgery and vesicostomy closure.
Patients And Methods:
From 1983 to 1990, nine boys (10-360 days old) with primary VUR were treated with an initial vesicostomy, followed by delayed closure of the vesicostomy and the simultaneous surgical correction of reflux. Severe VUR was detected bilaterally in seven and unilaterally in two infants at the time of the initial diagnosis. The mean (SD, range) age at vesicostomy was 12.4 (8, 3-23) months and the duration of bladder defunctionalization 38.7 (25.5, 18-90) months. All patients were assessed urodynamically after closing the vesicostomy, using rapid-fill cystometry with normal saline solution at room temperature. The mean (range) age at the time of urodynamic testing was 7.3 (5-15) years; the mean (SD, range) follow-up was 10.1 (4.1, 5-17) years.
Results:
Six boys with bilateral VUR underwent successful ureteroneocystostomy; nephroureterectomy was required in one patient. In two patients the VUR resolved with time. After re-functionalization, the mean (SD, range) maximum cystometric capacity, expressed as a percentage of the mean bladder capacity for age, was 1.4 (0.5, 0.6-2.2)%. In three patients the bladder capacity was higher (> or = 40%) than expected for age, while one had diminished (< 70%) bladder capacity. The mean (range) end-filling detrusor pressure was 14.5 (5-42) cmH2O and the mean (SD, range) compliance 24 (13.9, 4-44) mL/cmH2O. Two patients had a compliance of < 10 mL/cmH2O, one of whom had associated unstable detrusor contractions of 90 cmH2O. The mean (SD, range) detrusor voiding pressure at peak flow was 47.3 (16.8, 5-76) cmH2O. One patient had a residual urine volume of 8% of bladder capacity. At the follow-up, only one patient (aged 5 years) with detrusor instability had urinary incontinence.
Conclusion:
This study shows that the bladder of young infants with primary VUR treated with temporary vesicostomy regained normal function after re-functionalization of the lower urinary tract.
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