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Ileal enterocystoplasty and B12 deficiency in pediatric patients
David H Rosenbaum1, Mark P Cain, Martin Kaefer
1Division of Pediatric Urology, Riley Hospital for Children, Indianapolis, Indiana 46202, USA. rosenbad@iupui.edu
Insights
Pediatric patients undergoing ileal enterocystoplasty face a significant risk of vitamin B12 deficiency, which increases over time after surgery. Annual monitoring of serum B12 levels is recommended starting five years post-operation.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Nutritional Science
Background:
- Ileal enterocystoplasty is a surgical procedure used for bladder augmentation.
- Vitamin B12 deficiency is a potential complication, though not previously demonstrated in pediatric patients post-ileal enterocystoplasty.
- Understanding the risk and timing of this deficiency is crucial for patient management.
Purpose of the Study:
- To determine the incidence and timing of vitamin B12 deficiency in pediatric patients following ileal enterocystoplasty.
- To assess the correlation between time elapsed since surgery and serum vitamin B12 levels.
- To establish guidelines for monitoring vitamin B12 status in this patient population.
Main Methods:
- Retrospective review of serum vitamin B12 levels in pediatric patients (≤18 years) who underwent ileal enterocystoplasty.
- Exclusion of patients receiving vitamin B12 supplementation.
- Analysis of 105 vitamin B12 values from 79 patients, defining low B12 as ≤200 pg/ml and low-normal as 201-300 pg/ml.
Main Results:
- A statistically significant correlation was found between follow-up time and serum vitamin B12 levels (p=0.0001).
- The probability of low vitamin B12 increased with longer follow-up durations (p=0.007).
- At 7 years post-operation, 21% of patients had low B12 and 41% had low-normal B12 levels.
Conclusions:
- Pediatric patients who have undergone ileal enterocystoplasty are at risk for developing vitamin B12 deficiency.
- The risk of deficiency is highest starting 7 years postoperatively and escalates with time.
- Annual serum vitamin B12 monitoring is recommended for children starting 5 years after bladder augmentation.
Purpose:
Vitamin B12 deficiency is a feared complication of enterocystoplasty but it has never been demonstrated in pediatric patients who have undergone ileal enterocystoplasty. We reviewed our series of more than 500 bladder augmentations in an attempt to define the timing and risk of vitamin B12 deficiency in pediatric patients after bladder augmentation.
Materials And Methods:
From October 2004 to present we obtained serum B12 values in patients who had undergone bladder augmentation at our institution. We looked at patients who had undergone ileal enterocystoplasty and who were 18 years or younger at the time of augmentation. Any B12 value that was obtained while on any form of B12 supplementation was excluded. These criteria resulted in 79 patients with 105 B12 values. B12 values of 200 pg/ml or less were considered "low," and values between 201 and 300 pg/ml were considered "low-normal."
Results:
There was a statistically significant correlation between followup time and serum B12 (p = 0.0001). The probability of low B12 increased as followup time increased (p = 0.007), as did the probability of low-normal B12 (p = 0.005). Starting at 7 years postoperatively 6 of 29 patients (21%) had low B12 values, while 12 of 29 (41%) had low-normal values.
Conclusions:
Pediatric patients who have undergone ileal enterocystoplasty are at risk for development of vitamin B12 deficiency. These patients are at the highest risk beginning at 7 years postoperatively, and the risk increases with time. We recommend an annual serum B12 value in children beginning at 5 years following bladder augmentation.
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