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Enterocystoplasty in children with neuropathic bladders: long-term follow-up
P López Pereira1, J A Moreno Valle, L Espinosa
1Department of Pediatric Urology, University Hospital La Paz, P degrees Castellana 261, Madrid 28046, Spain. plpuro@hotmail.com
Insights
Enterocystoplasty in children with neuropathic bladders preserved kidney function and resolved urinary tract issues long-term. Lifelong monitoring is crucial for managing potential complications like proteinuria.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Neuropathic bladders in children often necessitate surgical intervention when conservative treatments fail.
- Augmentation cystoplasty before or during puberty is a critical procedure for managing these complex conditions.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of enterocystoplasty in children with neuropathic bladders.
- To assess the impact of this surgical augmentation on renal function, urinary tract integrity, and patient quality of life after a minimum of 8 years.
Main Methods:
- Retrospective analysis of 29 children with neuropathic bladders who underwent enterocystoplasty at a mean age of 11.8 years.
- Follow-up included regular urinary tract imaging, serum electrolytes, creatinine, urodynamic evaluation, 24-h urine collection, urine cytology, cystoscopy, and biopsy.
Main Results:
- Enterocystoplasty significantly improved bladder compliance and resolved upper urinary tract dilatation and vesicoureteral reflux (VUR) in most patients.
- Renal function remained normal in all patients, though some showed elevated cystatin C, significant proteinuria, and low renin/aldosterone levels.
- No new renal scarring occurred, and patients achieved dryness with normal urine cytology and cystoscopy findings.
Conclusions:
- Enterocystoplasty is effective in preserving renal function and resolving VUR and/or hydronephrosis in pediatric neuropathic bladders.
- Long-term implications of proteinuria and hormonal changes require further investigation.
- Close, lifelong follow-up, including cystoscopy, is essential for preventing complications.
Objective:
This study assesses clinical outcome, after at least 8 years, of augmentation done before or at puberty in neuropathic bladders.
Patients And Methods:
A total of 29 children with neuropathic bladders who did not respond satisfactorily to clean intermittent catheterisation and anti-cholinergic therapy underwent enterocystoplasty at a mean age of 11.8 years (range 3-18). Twenty-one children (72.4%) had vesicoureteral reflux (VUR) and/or ureterohydronephrosis and 22 (75.8%) had dimercapto-succinic acid scars, but all had normal renal function. All patients were followed at regular intervals with urinary tract imaging, serum electrolytes, creatinine, urodynamic evaluation and 24-h urine collection. Urine cytology, cystoscopy and biopsy were performed at the end of follow-up.
Results:
Mean follow-up was 11 years (range 8-14.5) and mean age at the end of follow-up was 22.2 years (range 13.2-31). Urodynamic studies showed a significant improvement in bladder compliance in all patients. Upper urinary tract dilatation disappeared in all, VUR in 13/17 (76.4%), and no new renal scarring occurred in any patient. At the end of follow-up, renal function was normal in all according to serum creatinine, but cystatin C levels were normal in 27 and elevated in two. Significant proteinuria and low concentrations of renin and aldosterone were present in 80% and 82%, respectively. Only one patient had urinary tract infection, three had bladder stones, and in another a catheterisable channel was made. All patients were dry with normal urine cytology and cystoscopy, and no malignant lesions have been found in the biopsy specimens.
Conclusion:
Enterocystoplasty has preserved renal function and resolved VUR and/or hydronephrosis in most patients. The future implications of proteinuria and the low serum levels of renin and aldosterone, as well as the best indicator for measuring renal function, have yet to be determined. Close, life-long follow-up, including cystoscopy, is necessary to prevent complications.
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