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Blood and urine analysis in patients with intestinal bladders
K E Wagstaff1, C R Woodhouse, G A Rose
1Institute of Urology, St Peter's Hospitals, London.
Insights
Patients with bowel pouches for bladder augmentation faced risks of anemia, acidosis, and infections. Delayed linear growth was observed in 20% of children, irrespective of pouch composition.
Area of Science:
- Urology
- Gastroenterology
- Pediatric Nephrology
Background:
- Bladder augmentation and reconstruction using bowel segments (ileum, colon) are common procedures.
- These procedures can lead to metabolic disturbances, infections, and long-term complications.
- Long-term outcomes, particularly in pediatric populations, require ongoing evaluation.
Purpose of the Study:
- To identify abnormal biochemical and hematological factors in patients with bowel-formed urinary pouches.
- To assess the incidence and risk factors for urinary tract infections (UTIs) and stone formation.
- To evaluate the impact on growth and development in pediatric patients.
Main Methods:
- Retrospective review of 183 patients with urinary pouches constructed from bowel segments.
- Analysis of biochemical (acid-base balance, folate levels) and hematological (anemia) parameters.
- Assessment of infection rates, stone formation, and linear growth over a minimum 1-year follow-up.
Main Results:
- Anemia (15 patients) and hyperchloraemic acidosis (25 definite, 40 borderline) were prevalent.
- Urinary infections occurred in 27.9% of patients; 25 patients developed stones (renal or pouch/bladder).
- Delayed linear growth affected 20% of pediatric patients, unrelated to weight gain or pouch type.
Conclusions:
- Bowel augmentation cystoplasty carries risks of metabolic derangements like acidosis and anemia.
- Infections and stone formation are significant complications, often linked to pouch composition and surgical materials.
- Growth impairment in children warrants further investigation, as it appears independent of metabolic status or pouch type.
Abstract:
A group of 183 patients whose urine was stored in pouches formed either wholly or partly from bowel was reviewed to establish abnormal biochemical and haematological factors and to assess the risk of infection. Minimum follow-up was 1 year (range 1-28.5, mean 3 years 8 months) and the mean age of the patients at follow-up was 16.5 years (range 4-43). Pouches were augmentation and substitution cystoplasties and complete reconstructions with bowel. Bowel segments were ileum (55 patients), colon (100) and mixed (28). Anaemia was found in 15 patients, folate deficiency in 2 and folate excess in 2. Definite hyperchloraemic acidosis was found in 25 patients and borderline results in 40. Most of these patients had colon in the pouch but 5 definite and 13 borderline cases had ileum only. Troublesome urinary infections occurred in 27.9% of patients; 3 developed renal stones and 22 developed pouch/bladder stones. Stones were usually associated with infection and/or staples. Delayed linear growth occurred in 20% of children in spite of a normal increase in weight; there was no difference in any of the measurements between those who grew and those who did not.