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Cumulative incidence of outcomes and urologic procedures after augmentation cystoplasty
Bruce J Schlomer1, Hillary L Copp2
1Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin, MC CCC-620, Houston, TX 77030, USA.
Insights
Augmentation cystoplasty (AC) outcomes are common in children, with significant risks like bladder stones and kidney disease. This study highlights the need for better strategies to reduce long-term complications following AC surgery.
Area of Science:
- Pediatric Urology
- Surgical Outcomes Research
- Nephrology
Background:
- Augmentation cystoplasty (AC) is a major surgical procedure for bladder augmentation.
- AC can be associated with significant long-term morbidity and the need for subsequent urologic procedures.
- Understanding the cumulative incidence of these outcomes is crucial for patient counseling and management.
Purpose of the Study:
- To determine the cumulative incidence of various outcomes and urologic procedures following AC in a large pediatric cohort.
- To identify key sources of morbidity associated with AC.
- To evaluate baseline patient factors that may predict outcomes after AC.
Main Methods:
- A retrospective cohort study using the Pediatric Health Information System (1999-2010) including children aged ≤18 years.
- Follow-up data were analyzed up to June 2012.
- Cumulative incidences were calculated using non-informative censoring, with sensitivity analyses performed. Multivariable Cox proportional hazards models were used to assess baseline factor associations.
Main Results:
- The study identified 2831 patients who underwent AC.
- 10-year cumulative incidence ranges for key outcomes included bladder rupture (2.9-6.4%), small bowel obstruction (5.2-10.3%), bladder stones (13.3-36.0%), and pyelonephritis (16.1-37.1%).
- Lower urinary tract obstruction strongly predicted chronic kidney disease (HR 13.7). Bladder neck surgery and stoma creation were associated with increased risks of bladder rupture and bladder stones, respectively.
Conclusions:
- Outcomes and urologic procedures are frequent after AC in children.
- Pyelonephritis, chronic kidney disease, further reconstructive surgery, and calculus disease represent significant morbidities.
- Results provide a basis for patient/family counseling and underscore the need for collaborative efforts to minimize AC-related morbidity.
Objective:
Augmentation cystoplasty (AC) is a major surgery that can be associated with long-term morbidity. This study aimed to describe the cumulative incidence of outcomes and urologic procedures in a large cohort of children who underwent AC, identify significant sources of morbidity, and to evaluate baseline factors associated with outcomes of interest.
Methods:
Children≤18 years who underwent AC in the Pediatric Health Information System from 1999 to 2010 were included. All follow-up encounters up to June 2012 were included. Cumulative incidences for 15 outcomes and urologic procedures were calculated using non-informative censoring. Sensitivity analyses were performed to determine effect of censoring assumptions and including hospitals without complete datasets. As an exploratory analysis, baseline patient factors were evaluated for associations with outcomes and urologic procedures of interest using multivariable Cox proportional hazards models adjusted for clustering by hospital.
Results:
2831 AC patients were identified. Based on cumulative incidence calculations and sensitivity analyses; the cumulative incidence ranges of outcomes and procedures at 1, 3, 5, and 10 years were calculated. Examples of 10-year cumulative incidence ranges are given for the following outcomes and procedures: bladder rupture (2.9-6.4%), small bowel obstruction (5.2-10.3%), bladder stones (13.3-36.0%), pyelonephritis (16.1-37.1%), cystolithopaxy (13.3-35.1%), and reaugmentation (5.2-13.4%). The development of chronic kidney disease was strongly associated with a diagnosis of lower urinary tract obstruction (HR 13.7; 95% CI 9.4-19.9). Bladder neck surgery and stoma creation at time of AC were associated with an increased hazard of bladder rupture (HR 1.9; 95% CI 1.1-3.3) and bladder stones (HR 1.4; 95% CI 1.1-1.8) respectively.
Conclusions:
Outcomes of interest and urologic procedures after AC are common. Results from this large cohort can be used to counsel patients and families about expectations after AC. Pyelonephritis, chronic kidney disease, further reconstructive surgery, and calculus disease appear to cause significant morbidity. Collaborative efforts are needed to further reduce morbidity in this patient population.
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