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Metabolic findings after colocystoplasty in children
P Vajda1, A B Pinter, F Harangi
1Department of Pediatrics, Surgical Unit, University of Pecs Faculty of Medicine, Pecs, Hungary.
Insights
Colocystoplasty can lead to metabolic changes in children, including bone demineralization. Sigmoid colon use appears to increase the risk of these metabolic issues compared to using the cecum and ascending colon.
Area of Science:
- Pediatric Surgery
- Urology
- Metabolic Research
Background:
- Colocystoplasty is a surgical procedure used to augment the bladder.
- Long-term metabolic effects in growing children are not fully understood.
- Different bowel segments (cecum/ascending colon vs. sigmoid colon) may have varying impacts.
Purpose of the Study:
- To investigate long-term metabolic changes in children following colocystoplasty.
- To compare metabolic outcomes based on the type of bowel segment used (cecum/ascending colon vs. sigmoid colon).
Main Methods:
- A study of 28 pediatric patients (mean age 11 years) undergoing colocystoplasty.
- Patients were divided into two groups: cecum/ascending colon (12) and sigmoid colon (16).
- Parameters monitored included linear growth, BMI, electrolytes, creatinine, urea, blood gases, pH, and alkaline phosphatase (ALP) pre- and post-surgery.
Main Results:
- Increased blood alkaline phosphatase (ALP) was observed in both groups.
- Sigmoid cystoplasty was associated with decreased serum sodium and calcium levels.
- Metabolic acidosis, hyperchloremia, and decreased linear growth were noted post-surgery, particularly with sigmoid colon use.
Conclusions:
- Colocystoplasty can lead to bone demineralization, indicated by increased ALP and decreased calcium.
- Bone demineralization appears more frequent after sigmoid cystoplasty compared to using the cecum and ascending colon.
- Monitoring metabolic parameters is crucial in children post-colocystoplasty.
Objectives:
To investigate whether colocystoplasty has resulted in metabolic changes in the growing child during long-term follow-up according to whether cecum with ascending or sigmoid colon was used.
Methods:
Twenty-eight patients (mean age at surgery 11 years) were included in the study and divided into two groups: group 1, cystoplasty with cecum and ascending colon (12 patients) and group 2, sigmoid cystoplasty (16 patients). Patients' linear growth, body mass index, and the following parameters were estimated before surgery and at 3, 6, and 12 months, and then yearly after surgery: blood and urine electrolytes (sodium, potassium, chloride, calcium, phosphorus, magnesium), creatinine, urea, blood gases, blood pH, urine pH, and blood alkaline phosphatase (ALP). All the data were statistically analyzed.
Results:
In group 1, the blood ALP increased significantly (P = 0.026) during follow-up. Severe metabolic acidosis with or without hyperchloremia was found in 7 patients. In group 2, the serum sodium and serum calcium levels decreased significantly (P = 0.014 and P = 0.003, respectively); however, the blood ALP, urine sodium, and urine phosphorus levels increased significantly (P = 0.033, P = 0.027, and P = 0.026, respectively) during follow-up. A statistically significant decrease in blood pH (P = 0.022) was found after surgery. Severe metabolic acidosis with or without hyperchloremia was detected in 5 patients. The average linear growth decreased significantly (P = 0.001 and P = 0.016, respectively) 1 and 2 years postoperatively.
Conclusions:
The statistically significant increase in blood ALP and decrease in serum calcium indicate bone demineralization after colocystoplasty. Our investigations in children suggest that bone demineralization is more frequent after sigmoid cystoplasty than after the use of cecum and ascending colon.
