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Long-term outcomes and risk factors for reoperation after ileal augmentation in children: A single-center study
Ahmet Asci1, Mesut Altan1, Mujdat Ayva1
1Hacettepe University Department of Urology, Adnan Saygun St, Altindag, Ankara, 06230, Turkey.
Insights
Ileal augmentation (IA) surgery for bladder anomalies carries risks of incontinence and reoperation, especially in bladder exstrophy-epispadias complex (BEEC) patients. Catheterizable stoma procedures (CSP) also increase reoperation risk, necessitating careful long-term management.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Lower urinary tract anomalies can lead to high-pressure, low-capacity bladders, risking incontinence and upper tract damage.
- Augmentation surgery (IA) is performed when conservative treatments fail to improve bladder capacity, continence, and protect the upper urinary tract.
- Long-term follow-up is crucial due to high reoperation rates, emphasizing the need to identify risk factors.
Purpose of the Study:
- To evaluate factors influencing reoperation, upper urinary tract deterioration (UUTD), and incontinence in pediatric patients undergoing ileal augmentation (IA).
Main Methods:
- Retrospective analysis of 131 pediatric patients undergoing IA surgery.
- Data collected included demographics, etiology, VUR, renal function, and associated procedures like anti-reflux surgery and catheterizable stoma procedures (CSP).
- Statistical analysis identified factors affecting postoperative incontinence, UUTD, and reoperation rates.
Main Results:
- New-onset UUTD occurred in 25.2% of patients; anti-reflux surgery and preoperative chronic renal disease were significant univariate factors.
- 34.3% of patients required reoperations, with bladder exstrophy-epispadias complex (BEEC) and CSP identified as significant risk factors for reoperation.
- Postoperative incontinence occurred in 25.9% of patients, with BEEC being a significant factor in multivariate analysis.
Conclusions:
- BEEC is linked to increased risks of postoperative incontinence and reoperation.
- CSP is associated with higher reoperation rates.
- While longer follow-up did not significantly impact incontinence or UUTD rates, reoperation rates appeared higher, underscoring the need for extended monitoring.
Introduction:
Patients with certain lower urinary tract anomalies may develop high-pressure, low-capacity bladders, risking incontinence and upper urinary tract damage. If conservative treatments fail, augmentation surgery aims to improve bladder capacity, maintain continence, and protect the upper urinary tract. Long-term follow-up is vital, as over half of patients may require reoperations, making identification of risk factors and optimal management important.
Aim:
To evaluate factors influencing the risk of reoperation, upper urinary tract deterioration (UUTD), and incontinence in children undergoing ileal augmentation (IA).
Patients And Methods:
A retrospective analysis was conducted on 131 patients who underwent IA surgery between July 1991 and January 2023 at a single center. Data included demographics, etiology, vesicoureteral reflux (VUR), preoperative renal function, anti-reflux surgery, bladder neck procedures, and catheterizable stoma procedures (CSP; Mitrofanoff/Monti). Factors affecting postoperative incontinence, UUTD, and reoperation rates were analyzed.
Results:
The mean age at operation was 9.5 ± 4.95 years, with 55 males and 76 females. Over a median follow-up of 65 months, new-onset UUTD was observed in 33 patients (25.2 %). Anti-reflux surgery (p = 0.033) and preoperative chronic renal disease (CRD) (p = 0.045) were significant in univariate analysis. A total of 91 reoperations were performed on 45 patients (34.3 %). Multivariate analysis identified bladder exstrophy-epispadias complex (BEEC, p = 0.013) and CSP (p = 0.022) as significant risk factors for reoperation. Postoperative incontinence occurred in 34 patients (25.9 %), with BEEC being significant in multivariate analyses (p < 0.001). Patients with follow-up exceeding 10 years had higher reoperation risk (48.3 % vs. 30.4 %, p = 0.081), though not statistically significant. Incontinence (27.6 % vs. 23.5 %, p = 0.633) and UUTD (27.6 % vs. 24.5 %, p = 0.809) rates were similar.
Discussion:
BEEC is associated with higher postoperative incontinence and reoperation risks. CSP was associated with higher reoperation risks. Longer follow-up periods did not seem to affect incontinence and UUTD rates, but reoperation rates seem to be higher.
Conclusion:
IA is a complex surgery requiring long-term follow-up. Certain patient groups are under higher risk for incontinence and reoperation. Longer follow-up periods may lead to higher reoperation rates.
Clinical Applicability:
Given the pediatric nature of this patient group and their long life expectancy, better knowledge of the long-term outcomes, complications, and the need for reoperations will aid in management of these complications and provide useful information for families towards the prognosis of this surgery.
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