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[The effect of enterocystoplasty in childhood on linear growth]
E W Gerharz1, M Preece, P G Duffy
1Urologische Klinik der Bayerischen Julius-Maximilians-Universität Würzburg. elmar.gerharz@klinik.uni-wuerzburg.de
Insights
Enterocystoplasty in children is unlikely to cause growth problems. Most patients maintained or improved their growth percentile after the surgery, with few experiencing clinically relevant growth disorders.
Area of Science:
- Pediatric Urology
- Pediatric Surgery
- Pediatric Endocrinology
Background:
- Previous studies suggested enterocystoplasty may negatively impact linear growth in children.
- This assumption was based on limited retrospective data from a decade ago.
Purpose of the Study:
- To re-evaluate the effect of enterocystoplasty on linear growth in a larger pediatric cohort.
- To provide a longer follow-up period than previous investigations.
Main Methods:
- A cohort of 123 children and adolescents who underwent enterocystoplasty between 1982 and 1997 was analyzed.
- Exclusion criteria included conditions affecting other organ systems, myelomeningocele, malignancy, reduced kidney function, and incomplete records.
- Growth data (height and weight measurements) were collected and analyzed pre- and post-operatively.
Main Results:
- The majority of patients (83% height, 80% weight) grew within two standard deviations of the 50th percentile.
- After surgery, 85% of patients either maintained or improved their growth percentile.
- Only 15.5% experienced a decrease in percentile, and clinically relevant growth disorders were rare and not attributed to the surgery.
Conclusions:
- A decrease in growth percentile after enterocystoplasty is likely a non-specific phenomenon.
- It is improbable that enterocystoplasty is a direct cause of significant growth impairment in most pediatric patients.
- The findings challenge the long-held assumption of detrimental effects on linear growth.
Objective:
The assumption that enterocystoplasty in children has a detrimental effect on linear growth has been based almost exclusively upon a chance finding in a retrospective study 10 years ago. We re-evaluated the same research question in a larger cohort and with a longer follow-up.
Patients And Methods:
Between 1982 and 1997, 242 children and adolescents underwent enterocystoplasty. 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:
In all, 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 the same or reached a higher percentile. Nineteen (15.5 %) were in a lower position, with a similar tendency in the weight percentile. 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 loss of the preoperative percentile position on the growth curve in 15 % of children after enterocystoplasty is a consequence of that particular 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.
