Influence of enterocystoplasty on linear growth in children with exstrophy

Many children with bladder exstrophy undergo reconstruction incorporating bowel into the lower urinary tract, which may result in metabolic changes affecting height. Linear growth in children with exstrophy who underwent enterocystoplasty was studied.

We retrospectively reviewed the charts of children with classic bladder exstrophy who underwent bladder augmentation with small or large bowel, or creation of a bowel neobladder before age 11 years. Mean followup plus or minus standard error was 9.4 +/- 0.9 years. Most patients were assessed yearly with measurement of height and serum electrolytes. Metabolic acidosis was treated with oral bicarbonate. Preoperative height percentiles at enterocystoplasty were compared to height percentiles at the most recent visit. In addition, height percentiles in a control group of individuals with exstrophy who did not undergo enterocystoplasty were compared to postoperative height percentiles in the enterocystoplasty group. The t test was used for statistical analysis.

Data on 18 children who underwent bladder reconstruction with bowel were compared with those on a control group of 18 with exstrophy. The mean preoperative height percentile at a mean age of 5.2 years was 35.6 +/- 4.5 and the postoperative height percentile at a mean age of 14.6 years was 20.3 +/- 5.7 (p <0.01). The mean height percentile in the control group at a mean age of 15.2 years was 30.6 +/- 7.8 (p <0.01 versus the postoperative height percentile in the study group. In the enterocystoplasty group 2 patients were receiving oral bicarbonate for metabolic acidosis. Five patients who underwent enterocystoplasty and 6 controls were below the third percentile for height.

In children with bladder exstrophy bladder augmentation or neobladder creation may have an adverse effect on linear growth. The height of children with bladder exstrophy is less than average compared with standard growth charts.