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Pediatric Patients Undergoing Enterocystoplasty and Risk of Metabolic Disease: A Single Center Retrospective Study
Melvin Chan1, Eliza Blanchette1, Kyle O Rove2,3
1Pediatrics, Division of Nephrology, Anschutz Medical Campus, and Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA.
Insights
High rates of overweight and obesity affect patients who undergo enterocystoplasty, particularly those with spina bifida or who have the augmentation before puberty. These findings highlight key risk factors for metabolic complications in this pediatric cohort.
Area of Science:
- Pediatric Surgery
- Metabolic Health
- Urology
Background:
- Enterocystoplasty, an augmentation ileum procedure for small bladder reservoirs, may impact metabolic health due to ileum's hormone production.
- The study investigates metabolic complications following enterocystoplasty, focusing on overweight, obesity, hypertension, type 2 diabetes, and fatty liver disease.
Purpose of the Study:
- To evaluate the incidence of metabolic complications in patients undergoing enterocystoplasty.
- To identify demographic and clinical risk factors associated with these complications, including spina bifida and timing of the procedure.
Main Methods:
- Retrospective review of patients undergoing enterocystoplasty at a pediatric tertiary center.
- Inclusion of a control registry of spina bifida patients without augmentation for comparison.
- Analysis of risk factors for overweight, obesity, hypertension, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease.
Main Results:
- 61% of the cohort developed overweight or obesity over a median 5-year follow-up.
- Enterocystoplasty itself was not a significant risk factor for overweight/obesity (HR: 1.3).
- Spina bifida (OR: 4.2) and enterocystoplasty before puberty (HR: 3.48) were significant risk factors for overweight/obesity.
Conclusions:
- Overweight and obesity rates are high in patients after enterocystoplasty.
- Spina bifida and undergoing enterocystoplasty before puberty are key risk factors for developing overweight/obesity.
- Further research may be warranted to mitigate these metabolic risks.
Introduction:
Enterocystoplasty is a procedure that uses the ileum to augment a small bladder reservoir. Because many of the anorexigenic intestinal hormones are produced in the ileum, this study evaluates the incidence of developing metabolic complications in patients undergoing augmentation.
Methods:
We retrospectively reviewed all patients who underwent an enterocystoplasty at a large pediatric tertiary center covering seven states. Because a large portion of patients undergoing enterocystoplasty had spina bifida, we included a separate control registry of spina bifida patients without augments. We evaluated both demographic and clinical risk factors for developing overweight, obesity, hypertension, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease.
Results:
A total of 112 patients were eligible for analysis, with a median follow up time of 5 years. Approximately 61% of this cohort developed overweight or obesity. We did not find enterocystoplasty to be a risk factor in developing overweight or obesity (HR: 1.3, 95% CI: 0.865-1.982). Notable risk factors were having spina bifida and having an enterocystoplasty before puberty (p = 0.001 and p < 0.001, respectively). The odds of developing overweight in the spina bifida patients was 4.2 (95% CI: 1.8-9.8). After adjusting for mobility, the hazard ratio of developing overweight or obesity was 3.48 (95% CI: 1.72-7.03) if a patient had enterocystoplasty before puberty versus later.
Conclusion:
The rates of developing overweight or overweight are high in this cohort. Specific risk factors for developing overweight include having spina bifida and undergoing enterocystoplasty before puberty.
Clinical Trial Registration Number:
None, as this is a retrospective study not involved in the study of a new medication or procedure.
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