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Long-term evaluation of metabolic profile and bone mineral density after ileocystoplasty in children
Ashraf T Hafez1, Gordon McLorie, David Gilday
1Divison of Urology, Hospital of Sick Children, University of Toronto, Ontario, Canada.
Insights
Ileocystoplasty in children with normal kidney function does not affect electrolytes or blood gases long-term. However, a significant portion experienced reduced bone mineral density (BMD), necessitating monitoring.
Area of Science:
- Pediatric Urology
- Pediatric Surgery
- Pediatric Nephrology
Background:
- Ileocystoplasty is a surgical procedure to augment bladder capacity using a segment of the ileum.
- Long-term effects on growth, metabolic parameters, and bone health in children are crucial for patient management.
Purpose of the Study:
- To assess the long-term impact of ileocystoplasty on linear growth, serum electrolytes, acid-base balance, and bone mineral density (BMD) in neurologically intact children.
- To identify potential risk factors associated with decreased BMD after ileocystoplasty.
Main Methods:
- A cohort of 25 neurologically intact children (mean age 6 years) underwent ileocystoplasty between 1988 and 1997 for various bladder conditions.
- Evaluated parameters included supine height, serum electrolytes, arterial blood gases, and BMD (L1-L4) using dual-energy absorptiometry, with a mean follow-up of 8.9 years.
Main Results:
- All patients maintained normal linear growth (mean 45th percentile) and had normal serum electrolytes and arterial blood gases.
- Bone mineral density (BMD) was normal in 68% of patients, while 32% showed varying degrees of osteopenia.
- Marked osteopenia was associated with factors like increased serum creatinine, radiotherapy history, or short bowel, but mild osteopenia occurred even without these cofactors.
Conclusions:
- Ileocystoplasty in children with preserved kidney function is safe regarding long-term electrolyte and acid-base balance.
- A notable percentage of children develop reduced bone mineral density (BMD) after ileocystoplasty.
- Routine preoperative and longitudinal BMD monitoring is recommended for children undergoing intestinal bladder augmentation.
Purpose:
We evaluated the long-term effects of ileocystoplasty on linear growth, serum electrolytes, acid-base profile and bone mineral density (BMD) in a group of neurologically intact children with a mean followup of 8.9 years.
Materials And Methods:
Between 1988 and 1997, 9 girls and 16 boys with a mean age of 6 years (range 1 month to 14 years) underwent ileocystoplasty for etiologies other than myelomeningocele and neuropathic bladder. Indications for ileocystoplasty were small noncompliant bladder secondary to bladder exstrophy in 12 cases, bladder outlet obstruction in 10 and post-partial cystectomy for rhabdomyosarcoma in 3. All patients underwent clinical evaluation, supine height measurement, serum electrolytes, arterial blood gases and BMD measurement using a fan beam dual energy absorpitometry scan. BMD was measured at L1-L4 and corrected for age and sex.
Results:
Followup ranged from 4 to 13 years (mean 8.9). Serum creatinine was normal in 20 of the 25 patients. All patients had normal supine height measurement with a mean of 45th (+/- 9) centile on growth charts. Serum electrolytes, calcium, phosphorus and arterial blood gases were normal in all patients. Mean BMD corrected for age and sex was 89 (+/- 10)%. BMD was normal in 17 of 25 (68%) patients. Mild reduction in bone density between 1 and 2 standard deviations below the age/sex mean was documented in 3 (12%) patients and the remaining 5 (20%) showed marked osteopenia of 2 or more standard deviations. Of the latter 5 patients 2 had increased serum creatinine, 1 had a history of radiotherapy for pelvic rhabdomyosarcoma and 2 had cloacal exstrophy and short bowel, all of which might have contributed to the osteopenia.
Conclusions:
Ileocystoplasty for children with normal kidney function is not associated with alterations in serum electrolytes or arterial blood gases in the long term. However, 32% of patients showed variable degrees of reduction in BMD. Although marked reduction in BMD was associated with cofactors, 12% of patients had evidence of mild osteopenia in absence of those cofactors. We recommend routine preoperative and longitudinal followup BMD measurements for children undergoing intestinal bladder augmentation.