Long-term renal functional outcomes after primary gastrocystoplasty

Area of Science:

• Urology
• Pediatric Surgery
• Nephrology

Background:

• Gastrocystoplasty is a surgical procedure used for bladder augmentation in pediatric patients.
• Long-term outcomes regarding renal function, morbidity, and mortality after primary gastrocystoplasty require further assessment.

Purpose of the Study:

• To evaluate the long-term renal function, morbidities, and mortality in patients who underwent primary gastrocystoplasty.
• To identify the incidence of end-stage renal disease, bladder malignancy, hematuria-dysuria syndrome, and the need for surgical revisions.

Main Methods:

• Retrospective review of patients (≤21 years) who underwent primary gastrocystoplasty between 1984 and 2004.
• Exclusion of patients with secondary gastrocystoplasty, primary composite augmentation, or cloacal exstrophy.
• Primary outcome: progression to end-stage renal disease. Secondary outcomes: mortality, bladder malignancy, hematuria-dysuria syndrome, electrolyte abnormalities, surgical revisions.

Main Results:

• Of 35 eligible patients (median age 9.4 years, 19-year follow-up), 14% had stage 3-4 chronic kidney disease preoperatively.
• Five patients with pre-existing CKD improved renal function; 9 progressed to end-stage renal disease. One patient with normal GFR developed ESRD.
• 20% mortality rate (causes included UTI, septic shock, ESRD, pregnancy complications); no bladder malignancies; 24% developed hematuria-dysuria syndrome; 23% required surgical revision.

Conclusions:

• The majority of patients maintained or improved renal function following gastrocystoplasty.
• Gastrocystoplasty was not associated with deaths directly attributable to the augmentation or bladder malignancies.
• Approximately one-fourth of patients required subsequent surgical interventions.