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Augmentation ileocystoplasty in children with myelodysplasia
E M Webber1, P G Crofts, C Pomeroy
1Department of Surgery, B.C. Children's Hospital, University of British Columbia, Vancouver.
Insights
Augmentation ileocystoplasty effectively treated urinary incontinence in 20 children with myelodysplasia, achieving continence in 16 patients. While generally safe, potential complications like delayed perforation require monitoring.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Bladder Reconstruction
Background:
- Myelodysplasia frequently causes refractory urinary incontinence in children.
- Current treatments like clean, intermittent catheterization and anticholinergic agents may be insufficient.
- Surgical intervention is often necessary for managing complex bladder dysfunction.
Purpose of the Study:
- To evaluate the efficacy and safety of augmentation ileocystoplasty in pediatric patients with myelodysplasia.
- To assess the long-term outcomes of urinary continence following the procedure.
- To identify potential complications associated with augmentation ileocystoplasty in this population.
Main Methods:
- A cohort of 20 children (aged 5-17 years) with myelodysplasia underwent augmentation ileocystoplasty.
- Procedures were performed over 8 years, with follow-up ranging from 6 months to 7 years.
- Concurrent procedures included urinary undiversion, vesicostomy closure, and bladder outlet repair.
Main Results:
- 16 out of 20 children achieved full urinary continence with clean, intermittent catheterization and anticholinergic medication.
- Three male patients did not achieve satisfactory continence.
- Two patients experienced delayed bladder perforation several months postoperatively, a serious complication.
Conclusions:
- Augmentation ileocystoplasty is a viable surgical option for achieving urinary continence in pediatric myelodysplasia patients.
- The procedure demonstrates a high success rate, but careful patient selection and monitoring are crucial.
- Potential complications, including delayed perforation, necessitate vigilant postoperative surveillance.
Abstract:
Over the past 8 years 20 children suffering from myelodysplasia were selected to undergo augmentation ileocystoplasty for urinary incontinence refractory to treatment by clean, intermittent catheterization and anticholinergic agents, or as part of urinary undiversion. The children ranged in age from 5 to 17 years, and the follow-up ranged from 6 months to 7 years. Three children underwent undiversion, two had vesicostomy closure and six had bladder outlet repair at the time of augmentation. In one patient, surgery was technically impossible. Postoperatively 16 children were fully continent on clean, intermittent catheterization and anticholinergic medication. Three boys failed to achieve satisfactory continence. Delayed perforation, a potentially serious complication, occurred in two patients several months postoperatively.