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Perforation of the augmented bladder in patients undergoing clean intermittent catheterization
J S Elder1, H M Snyder, W C Hulbert
1Division of Urology, Children's Hospital of Philadelphia, Pennsylvania.
The Journal of Urology
|November 1, 1988
Summary
Sigmoid cystoplasty for bladder augmentation can lead to serious urinary reservoir perforation, a rare but potentially fatal complication. Early consideration of perforation is crucial in patients with abdominal pain post-surgery.
Area of Science:
- Urology
- Surgical Innovation
- Pediatric Surgery
Background:
- Urological reconstructive surgery often utilizes bowel segments to augment bladder capacity or create urinary reservoirs.
- Clean intermittent catheterization (CIC) is typically required for urinary drainage in these patients.
Observation:
- This report details four patients with sigmoid cystoplasty undergoing CIC who developed urinary reservoir perforation.
- Two patients were adolescent girls with myelodysplasia, and two were prepubertal boys with bladder exstrophy.
- One patient experienced two separate perforation events, with rupture occurring 15-48 months post-reconstruction.
Findings:
- Diagnosis was challenging, with static cystograms showing extravasation in only half of the cases; ultrasound was also used.
- Management involved intravenous antibiotics and open abscess drainage for all affected patients.
- One patient succumbed to the complication, highlighting its potential severity.
Implications:
- Urinary reservoir perforation is a serious long-term complication of sigmoid cystoplasty.
- Abdominal pain and distension in patients with augmentation cystoplasty or continent diversion warrant consideration of reservoir perforation.
- This underscores the need for vigilance and prompt diagnosis in managing these complex reconstructive cases.