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Linear growth after enterocystoplasty in children and adolescents: a review
Gerald Mingin1, Paul Maroni, Elmar W Gerharz
1Division of Pediatric Surgical Research, Denver Children's Hospital, University of Colorado, 1056 East 19th Avenue, Denver, Colorado 80218, USA.
Insights
Bladder augmentation using bowel preserves kidney function and continence in children. Long-term studies show metabolic acidosis and bone metabolism issues are rare, with linear growth generally unaffected by this urologic surgery.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Pediatric Nephrology
Background:
- Bowel interposition in the urinary tract aids renal function and continence in pediatric patients with bladder exstrophy, neurogenic bladder, and valve bladder.
- While bladder augmentation using ileum or colon is considered safe, long-term effects on metabolic acidosis, linear growth, and bone metabolism require further investigation.
Purpose of the Study:
- To critically review existing literature on linear growth in children following bladder augmentation.
- To examine the correlation between acid-base status, bone mineralization, and growth in these patients.
Main Methods:
- Literature review of studies focusing on bladder augmentation in children.
- Analysis of data correlating metabolic acidosis and bone metabolism with linear growth outcomes.
Main Results:
- Most studies indicate that linear growth is not significantly impacted by bladder augmentation.
- Short-term metabolic acidosis post-augmentation typically resolves without affecting linear growth.
- One study noted bone demineralization a decade after surgery, yet linear growth remained unaffected. Short-term follow-up showed no bone density alterations.
Conclusions:
- Bladder augmentation with bowel segments appears to have a generally neutral effect on long-term linear growth in children.
- While metabolic acidosis can occur short-term, it usually resolves and does not impede growth. Bone health requires continued monitoring, though significant growth impairment is uncommon.
Abstract:
The interposition of bowel in continuity with the urinary tract has allowed for the preservation of renal function and continence in children with bladder exstrophy, as well as neurogenic and valve bladders. Although bladder augmentation with ileum or colon has been shown to be safe, the long-term effects of metabolic acidosis in addition to abnormalities in linear growth and bone metabolism remain largely unknown. We reviewed the literature to critically examine linear growth in children who have had bladder augmentation with a particular emphasis on the correlation between acid-base status, bone mineralization and growth. The majority of studies suggest that linear growth is not affected by bladder augmentation. In the short-term, children post-augmentation have varying degrees of metabolic acidosis which, overtime, appears to resolve with no affect on linear growth. In a single study, bladder augmentation led to significant bone demineralization almost a decade after surgery, however, even in these children no decrease in linear growth was noted. No alterations in bone density levels were seen with short-term follow-up.