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Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk
P D Metcalfe1, A J Casale, M A Kaefer
1Division of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA. pmetcalf@iupui.edu
Insights
Spontaneous bladder perforation is a serious complication after augmentation cystoplasty, occurring in 8.6% of patients. Risk factors include sigmoid colon use and bladder neck surgery, while continent channels may reduce risk.
Area of Science:
- Urology
- Surgical Complications
- Bladder Augmentation
Background:
- Spontaneous bladder perforation is a rare but severe complication following bladder augmentation.
- Understanding its incidence and risk factors is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of spontaneous bladder perforation after augmentation cystoplasty.
- To identify associated risk factors for this complication.
Main Methods:
- Retrospective chart review of 500 bladder augmentation procedures.
- Minimum follow-up of 2 years for all patients.
Main Results:
- Spontaneous perforations occurred in 43 patients (8.6%), with 54 total events.
- Increased risk associated with sigmoid colon use and bladder neck surgery.
- Continent catheterizable channels correlated with decreased perforation risk.
Conclusions:
- This large series provides significant insights into spontaneous bladder perforation after augmentation.
- Identified risk factors can guide surgical decision-making and future research.
Purpose:
The spontaneous perforation of an augmented bladder is an uncommon but serious complication. To our knowledge our institution has the largest reported series of bladder augmentations. We examined our data to determine the incidence of spontaneous bladder perforation and to delineate associated risk factors.
Materials And Methods:
We performed a retrospective chart review of 500 bladder augmentation procedures performed during the preceding 25 years with a minimum followup of 2 years.
Results:
Spontaneous perforations occurred in 43 patients (8.6%), for a total of 54 events. The calculated risk was 0.0066 perforations per augmentation-year at risk. Approximately a third of the cases had perforated within 2 years of surgery, a third between 2 and 6 years postoperatively, and a third at more than 6 years after augmentation. Patients who underwent augmentation between 1997 and 2003 had a higher rate of perforation within 2 years of surgery than those operated on between 1978 and 1987. Increased risk of perforation was observed with the use of sigmoid colon and bladder neck surgery. A decreased risk was associated with the presence of a continent catheterizable channel.
Conclusions:
We believe that this large and comprehensive series gives valuable insight into this serious complication. The delineation of these potential risk factors serves as a guide for further discussion and investigation.
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