Probability of Bladder Augmentation, Diversion and Clean Intermittent Catheterization in Classic Bladder Exstrophy: A
Konrad M Szymanski1, Molly Fuchs2, Daryl Mcleod2
1Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
Insights
The probability of bladder augmentation or diversion increases with age in classic bladder exstrophy patients, with most requiring it by adulthood. Many patients, even with native bladders, successfully use clean intermittent catheterization long-term.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Long-term Outcomes
Background:
- Classic bladder exstrophy (CBE) presents complex reconstructive challenges.
- Long-term management strategies for CBE focus on bladder augmentation/diversion and bladder management.
- Clean intermittent catheterization (CIC) is a key component of bladder management in many urological conditions.
Purpose of the Study:
- To assess the long-term probability of bladder augmentation or diversion in patients with classic bladder exstrophy.
- To determine the proportion of patients performing clean intermittent catheterization (CIC) at last follow-up.
- To analyze factors influencing these outcomes in a multi-institutional cohort.
Main Methods:
- Retrospective analysis of a multi-institutional cohort of 216 patients with classic bladder exstrophy (born 1980-2016).
- Inclusion criteria: diagnosis of CBE, minimum 1-year follow-up. Exclusion criteria: isolated epispadias, bladder exstrophy variants.
- Outcomes assessed: probability of bladder augmentation/diversion post-closure, CIC rates at last follow-up. Survival analysis was employed.
Main Results:
- The probability of bladder augmentation/diversion increased with age, reaching 50.7% by 10 years and 70.1% by 18 years.
- Significant institutional variation in augmentation/diversion rates was observed (p=0.01).
- At last follow-up, 67.4% of the cohort performed CIC; 30.5% of those with intact native bladders and 100% with augmented bladders performed CIC.
Conclusions:
- The need for bladder augmentation/diversion in classic bladder exstrophy is age-dependent, with a majority requiring intervention by adulthood.
- Institutional practices significantly impact the rates of bladder augmentation/diversion.
- Clean intermittent catheterization is a feasible and effective long-term management strategy for a substantial proportion of patients, including those with native bladders.
Purpose:
We assessed the probability of bladder augmentation/diversion and clean intermittent catheterization in classic bladder exstrophy in a multi-institutional cohort.
Materials And Methods:
We included children born from 1980 to 2016 with bladder exstrophy and treated across 5 centers (exclusion criteria less than 1 year followup after birth, isolated epispadias, bladder exstrophy variants etc). Outcomes were probability of bladder augmentation/diversion after bladder closure and proportion of patients performing clean intermittent catheterization at last followup. Survival analysis was used.
Results:
Of 216 patients 63.4% were male (median followup 14.4 years). Overall 4 patients (1.9%) underwent primary diversion and 212 underwent primary closure (72.6% in first week of life). After primary closure 50.9% underwent augmentation, 4.7% diversion and 44.8% neither. By age 18 years 88.5% underwent a bladder neck procedure (synchronous augmentation 27.3%). On survival analysis the probability of bladder augmentation/diversion was 14.9% by age 5 years, 50.7% by 10 years and 70.1% by 18 years. Probability of bladder augmentation/diversion varied significantly between centers (p=0.01). Probability of bladder augmentation/diversion was 60.7% 10 years after bladder neck procedure. At last followup of the entire cohort 67.4% performed clean intermittent catheterization. Among 95 patients with intact native bladders 30.5% performed clean intermittent catheterization (channel 72.4%). Among 76 adults without a diversion 85.5% performed clean intermittent catheterization (augmented bladder 100.0% clean intermittent catheterization, native bladder 31.3%). Fifteen patients underwent diversion (continent 8, ureterosigmoidostomy 5, incontinent 2).
Conclusions:
On long-term followup probability of bladder augmentation/diversion increased with age, with 1 in 2 patients by age 10 years and the majority in adulthood. Probability of bladder augmentation/diversion differed among institutions. Almost a third of patients, including adults, with a closed native bladder performed clean intermittent catheterization. Considering all adults only 14% did not perform clean intermittent catheterization.
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