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Published on: August 9, 2012
Bladder augmentation in exstrophy vesicae: Long-term results of a single experienced center
Hasan Demirkan1, Mehmet Özgür Kuzdan2
1Department of Pediatric Urology, Kanuni Sultan Süleyman Training and Research Hospital/Health Sciences University, İstanbul, Turkey.
Insights
Long-term bladder augmentation, closure, and Mitrofanoff catheterization offer good urinary continence for bladder exstrophy. Augmentation is key for dryness, though stones can occur, especially with colocystoplasty.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Long-term Outcomes
Background:
- Bladder exstrophy (BE) presents complex management challenges.
- Established surgical techniques include bladder augmentation (BA), bladder neck closure, and Mitrofanoff clean intermittent catheterization (CIC).
Purpose of the Study:
- To evaluate the long-term treatment outcomes of BA, bladder neck closure, and Mitrofanoff CIC in managing bladder exstrophy.
- To assess surgical interventions, stone formation, hydronephrosis, and continence status in pediatric BE patients.
Main Methods:
- Retrospective review of medical records for 33 children with BE.
- Data collected from 1988 to 2020 at a tertiary pediatric urology clinic.
- Analysis of surgical history, renal calculi, hydronephrosis, and urinary continence.
Main Results:
- Median follow-up of 18.2 years.
- Urinary stones occurred in 30.3% of cases, more frequently after colocystoplasty (33.3%) than ileocytoplasty (16.6%).
- Satisfactory continence achieved in 78.7% of patients; 18.1% remained incontinent. No hydronephrosis in 69.6%; VUR present in 36.3%.
Conclusions:
- Surgical reconstruction for BE can lead to satisfactory long-term urinary continence.
- BA, bladder neck closure, and Mitrofanoff CIC are critical in managing classic BE.
- Augmentation is essential for achieving dryness and high continence rates in BE patients.
Background:
In this study, we present our long-term treatment outcomes of bladder augmentation (BA), bladder neck closure, and Mitrofanoff clean intermittent catheterization (CIC) in managing bladder exstrophy (BE).
Methods:
This was a retrospective medical records' review of 33 children diagnosed as born with BE, followed up at a tertiary pediatric urology clinic from 1988 to 2020. Outcomes such as surgical interventions, presence of renal calculi, hydronephrosis, and continence status were extracted.
Results:
The median follow-up of the group was 18.2 (4-26) years. Urinary system stones developed in 10 (30.3%) cases about 8.9 years after BA. Stone development was two times more common in patients who underwent colocystoplasty (33.3%) than those who underwent ileocytoplasty (16.6%). The state of continence of the group was satisfactory in 26 (78.7%; excellent in 23; good in 3 cases) and unsatisfactory (wet) in 6 (18.1%) cases. At the last visit, ultrasonography revealed no hydronephrosis in 23 (69.6%) patients, and the voiding cystourethrogram demonstrated low-grade vesicoureteral reflux in 10 (30.3%) and high-grade vesicoureteral reflux in 2 (6%) patients.
Conclusions:
An elaborated plan of surgical reconstruction for classic BE can lead to satisfactory long-term urinary continence in most patients. Ultimate predictors of outcome in BE repair are difficult to ascertain. Consistently, BA, bladder neck closure, and Mitrofanoff CIC continue to stand out at a critical point in the management of those patients with classic BE. Our study demonstrated that augmentation is required to achieve acceptable dryness with high satisfactory dryness rates in BE.
