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Enterocystoplasty in childhood: a second look at the effect on growth
E W Gerharz1, M Preece, P G Duffy
1The Institute of Urology, Royal Free and University College London Medical School, UK. elmar.gerharz@mail.uni-wuerzburg.de
Insights
Enterocystoplasty in children does not significantly impact linear growth. Most patients maintain or improve their growth percentile, with only a small percentage experiencing a drop unrelated to the surgery.
Area of Science:
- Pediatric Urology
- Pediatric Surgery
- Growth and Development
Background:
- Previous studies suggested enterocystoplasty negatively affects linear growth in children, based on limited retrospective data.
- This assumption has persisted for a decade, influencing clinical decisions regarding bladder augmentation in pediatric patients.
Purpose of the Study:
- To re-evaluate the impact of enterocystoplasty on linear growth in a larger cohort of children with longer follow-up.
- To challenge the long-held belief of detrimental effects on growth stemming from a single, older study.
Main Methods:
- A cohort of 123 children and adolescents who underwent enterocystoplasty between 1982 and 1997 was studied.
- Exclusion criteria included conditions affecting other organ systems, myelomeningocele, malignancy, or impaired renal function.
- Growth data, including height and weight percentiles, were analyzed pre- and post-surgery.
Main Results:
- Of the original 12 patients with prior growth concerns, six improved their growth chart position.
- In the larger cohort, 85% of patients remained on their preoperative growth centile or moved to a higher one.
- Only 15.5% experienced a decrease in height percentile, and clinically relevant growth disorders were not attributed to enterocystoplasty.
Conclusions:
- Enterocystoplasty is unlikely to cause a significant detrimental effect on linear growth in children.
- A decrease in growth percentile after surgery is likely a non-specific phenomenon, not directly caused by the enterocystoplasty procedure itself.
Objective:
To re-evaluate the assumption that enterocystoplasty in children has a detrimental effect on linear growth (which is almost exclusively based upon a chance finding in a retrospective study 10 years ago) in a larger cohort and with a longer follow-up.
Patients And Methods:
The original 12 children who had impaired linear growth in a previous study 10 years earlier were re-measured. A larger cohort was identified from the 242 children and adolescents who had undergone enterocystoplasty between 1982 and 1997. Patients with conditions involving organ systems apart from the urinary tract, and those with myelomeningocele, malignant diseases, reduced glomerular filtration rate and incomplete notes were excluded. In the definitive study cohort (123; mean age at operation 8.6 years; mean age at investigation 16.8 years) enterocystoplasty had been undertaken using colon in 70, ileum in 37, a combination of both in 11, ileocaecal segments in three and stomach in two patients.
Results:
Of the original 12 patients, six had regained or surpassed their preoperative position on their growth charts. In all patients with a known target centile range the final height was within their genetic growth potential. In the cohort of 123 patients, 1215 height and weight measurements had been recorded. The distribution of percentile positions before and after enterocystoplasty showed a normal configuration, with 83% and 80% of patients growing within two standard deviations of the 50th percentile. After surgery, 85% either remained on the same or reached a higher centile. Nineteen (15.5%) were in a lower position, with a similar tendency in the weight centile. A clinically relevant growth disorder was recognized in four patients with a complete endocrinological evaluation; in none of these was enterocystoplasty thought to be a causal factor.
Conclusions:
It is very unlikely that the loss of the preoperative percentile position on the growth curve in 15% of children after enterocystoplasty is a consequence of the surgery. Rather it is a non-specific phenomenon that has to be considered in any clinical population of the same size and age distribution after the same length of time.