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Complications after augmentation enterocystoplasty in children
Alicia Gómez Sánchez1, Cristina Tordable Ojeda2, Sara Monserrat Proaño Landázuri2
1Department of Pediatric Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain. alicigom@gmail.com.
Insights
Augmentation enterocystoplasty for pediatric lower urinary tract dysfunction often leads to complications, with over 85% of patients experiencing issues. Bladder exstrophy and bladder neck surgery increase complication risks in these patients.
Area of Science:
- Pediatric Urology
- Surgical Complications
- Lower Urinary Tract Dysfunction
Background:
- Lower urinary tract dysfunction in children often stems from neurogenic or anatomic issues.
- Augmentation enterocystoplasty is a surgical option for refractory cases, offering functional benefits but carrying risks.
Purpose of the Study:
- To evaluate the incidence and types of complications following augmentation enterocystoplasty in pediatric patients.
- To identify risk factors associated with complications after bladder augmentation surgery.
Main Methods:
- Retrospective review of 34 pediatric patients undergoing augmentation enterocystoplasty over 25 years.
- Statistical analysis to determine factors linked to complication occurrence.
Main Results:
- 88.2% of patients (30/34) experienced 90 complications; 82.4% required reoperation.
- Most frequent complications included lithiasis, stoma issues, and urinary tract infections.
- Bladder exstrophy, bladder neck surgery, and catheterizable stoma were associated with significantly higher complication rates.
Conclusions:
- Augmentation enterocystoplasty in pediatric patients has a high complication rate, exceeding 85%.
- Patients with bladder exstrophy and those undergoing bladder neck procedures face elevated risks.
Introduction:
In the pediatric population, lower urinary tract dysfunction, usually, is due to neurogenic or anatomic defects. In this context, when conservative treatment fails, augmentation enterocystoplasty is a treatment option with good functional results. Nevertheless, multiple complications have been associated with this technique.
Methods:
We conducted a retrospective review of the patients who underwent bladder augmentation surgery at our hospital over the past 25 years. Statistical analyses were performed to identify potential factors associated with the occurrence of complications.
Results:
A total of 34 patients underwent augmentation enterocystoplasty during the study period. A total of 90 complications were recorded in 30 patients (88.2%). The average number of complications per patient was 2.6 ± 1.9. Reintervention was required in 28 patients (82.4%) due to complications, with a mean of 2.29 reoperations per patient. The most frequent complication was lithiasis (17/90), followed by stoma-related issues in the catheterizable duct (14/90), and urinary tract infections (10/90). Patients with exstrophy (p = 0.0028, IRR 3.4, 95% CI 1.71-6.78), bladder neck surgery (p = 0.014, IRR 2.04, 95% CI 1.29-3.21), and catheterizable duct (p = 0.002, IRR 2.56, 95% CI 1.61-4.06) had a significantly higher number of complications.
Conclusions:
In our study, over 85% of patients who underwent bladder augmentation surgery experienced at least one complication during follow-up. The risk was significantly higher in patients with bladder exstrophy and in those who had a bladder neck procedure.
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