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Published on: August 9, 2012
Complications after bladder augmentation in children
Carlos Augusto Fernandes Molina1, Gilson José de Lima2, Marcelo Ferreira Cassini3
1Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil.
Insights
Bladder augmentation surgery effectively increased bladder capacity in pediatric patients with congenital anomalies. The procedure demonstrated good results, preserving renal function and improving urinary issues in most cases.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Bladder augmentation is crucial for managing complex bladder anomalies.
- Patients with spina bifida, myelomeningocele, and bladder exstrophy often require surgical intervention due to medication intolerance.
- Enhancing bladder capacity and reducing urinary system pressure are key treatment goals.
Purpose of the Study:
- To evaluate the efficacy and outcomes of bladder augmentation in pediatric patients.
- To assess the impact of bladder augmentation on renal function and vesicoureteral reflux.
- To analyze complications associated with bladder augmentation procedures.
Main Methods:
- Retrospective study of pediatric patients undergoing bladder augmentation between 2000 and 2011.
- Analysis of surgical techniques including ileal loop and ureter augmentation.
- Inclusion of continent urinary diversion techniques like Mitrofanoff conduit and Macedo technique.
Main Results:
- 34 pediatric patients (ages 4-17) underwent bladder augmentation, primarily using ileal loops.
- Significant increase in mean bladder capacity from 152.5 ml to 410 ml.
- High success rate in resolving or improving vesicoureteral reflux (83.5% right, 75% left); 3 patients required renal transplant; complications included lithiasis and conduit perforation.
Conclusions:
- Bladder augmentation is an effective procedure for pediatric patients with bladder anomalies.
- The surgery demonstrated positive outcomes in increasing bladder capacity and managing urinary issues.
- Renal function was preserved in the majority of patients, highlighting the procedure's safety and efficacy.
Purpose:
Bladder augmentation is an effective surgical procedure for increasing bladder capacity and reducing pressure on the urinary system. It is indicated for patients with anomalies such as spina bifida, myelomeningocele, urethral valve and bladder exstrophy, who progress with low tolerance of medication.
Cases:
This was a retrospective study conducted on pediatric patients submitted to bladder augmentation from 2000 to 2011.
Results:
34 patients aged 4 to 17 years were submitted to bladder augmentation, 30 of them with an ileal loop and 4 with a ureter.A continent urinary shunt was performed in 16 patients, the Mitrofanoff conduit was associated in 15, and the Macedo technique was used in one. Mean follow-up was 34.35 months (1 to 122 months). Mean creatinine was 1.5 ng/ml (0.4 to 7.5 ng/ml) preoperatively and 1.78 ng/ml postoperatively. Three patients required a renal transplant during follow-up. There was improvement or resolution of vesicoureteral reflux in 83.5% of the kidneys on the right and in 75% on the left. Bladder capacity increased, on average, from 152.5 ml to 410 ml. The main complications were vesical lithiasis in 3 patients and conduit perforation in one.
Conclusion:
Bladder augmentation showed good results in this series, preserving renal function in most of the patients.
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