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Gastrocystoplasty in children
1Department of Paediatric Urology, Hospital for Sick Children, London.
Insights
Gastrocystoplasty offers excellent outcomes for children with kidney issues, improving bladder function. Careful gastric patch sizing is crucial to manage acid secretion, especially with post-transplant medications.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Children with compromised renal function often require bladder augmentation.
- Intestinal segments have traditionally been used, but carry risks.
- Gastrocystoplasty presents an alternative for bladder enhancement.
Purpose of the Study:
- To evaluate the efficacy and safety of gastrocystoplasty in children with impaired kidney function.
- To assess the physiological and biochemical outcomes of the procedure.
- To identify potential complications and contributing factors.
Main Methods:
- Retrospective review of 8 children undergoing gastrocystoplasty.
- Analysis of pre- and post-operative biochemical and urodynamic parameters.
- Investigation of symptomatic aciduria in select cases.
Main Results:
- Excellent physiological outcomes with improved biochemical and urodynamic parameters in all patients.
- Six patients became asymptomatic and discontinued H2-receptor blockers.
- Two patients experienced significant acid secretion-related symptoms, linked to gastric patch size or immunosuppressive therapy.
Conclusions:
- Gastrocystoplasty is a highly satisfactory alternative for bladder enhancement in children with compromised renal function.
- Gastric patch size is critical for managing acid secretion.
- The impact of post-transplantation immunosuppressive therapy on acid production warrants further investigation.
Abstract:
We report our experience of gastrocystoplasty in 8 children (mean age 10.1 years) with compromised renal function (mean creatinine 186 mmol/l, mean glomerular filtration rate 39 ml/min/1.73 m2). Current follow-up ranges from 11 to 35 months (mean 21). The physiological outcome of the procedure has been excellent, with improved biochemical and urodynamic parameters in all cases. Six patients are off H2-receptor blockers and are asymptomatic. In 2 children we have encountered significant symptoms related to acid secretion in the bladder. Detailed investigations suggest that the excess aciduria is related to the size of the gastric patch in 1 patient. The second child underwent renal transplantation 5 months after gastrocystoplasty and it is postulated that his immunosuppressive regimen (which includes prednisolone) may be responsible for the increased acid secretion. It is concluded that gastrocystoplasty is a very satisfactory alternative to intestinal segment bladder enhancement in children with compromised renal function, but the size of the gastric patch is critical in determining the resultant acid secretion. Post-transplantation immunosuppressive therapy may increase acid production from the gastric patch; since the children most suitable for gastrocystoplasty are also those likley to require transplantation, this aspect requires further study.