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Severe perineal pain after enterocystoplasty in bladder exstrophy
1Great Ormond Street Hospital for Children NHS Trust, London, UK.
BJU International
|March 31, 2004
Summary
Severe perineal pain after bladder reconstruction in bladder exstrophy patients was treated by bladder remnant excision (cystectomy). This procedure resolved the pain and potentially removed a future cancer risk.
Area of Science:
- Pediatric Urology
- Surgical Complications
- Bladder Exstrophy Management
Background:
- Bladder reconstruction and enterocystoplasty are common procedures for bladder exstrophy.
- A severe perineal pain complication following these procedures has not been previously reported.
- This pain can significantly impact patient quality of life.
Purpose of the Study:
- To describe a novel complication of severe perineal pain after bladder reconstruction in bladder exstrophy.
- To report the outcomes of surgical intervention for this complication.
Main Methods:
- Retrospective review of four patients with classical bladder exstrophy experiencing severe perineal/penile pain post-reconstruction.
- Patients underwent extensive investigations including imaging and urodynamics.
- Failed conservative management led to native bladder excision (cystectomy).
Main Results:
- All four patients developed severe pain months to years after bladder augmentation.
- Standard treatments were ineffective.
- Following cystectomy, all patients experienced complete pain resolution with 2-6 years follow-up.
- Histology revealed abnormal urothelium and squamous metaplasia in excised bladders.
Conclusions:
- Severe referred bladder pain in these patients was likely due to abnormal bladder remnants.
- Cystectomy effectively treated the pain.
- Cystectomy may mitigate the risk of future malignancy in retained bladder tissue.