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Ileocystoplasty in children: assessing safety and success
A Krishna1, D C Gough, J Fishwick
1Division of Paediatric Urology, Royal Manchester Children's Hospital, UK.
Insights
Clam ileocystoplasty effectively increased bladder capacity in children, resolving hydroureteronephrosis and reducing infections. However, complications like bladder rupture occurred in some cases.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Bladder Augmentation
Background:
- Bladder dysfunction in children often necessitates surgical intervention.
- Clam ileocystoplasty is a technique used for bladder augmentation.
Purpose of the Study:
- To evaluate the efficacy and safety of clam ileocystoplasty in pediatric patients.
- To assess outcomes such as bladder capacity, upper tract changes, and complications.
Main Methods:
- Retrospective analysis of 39 children (1.5-17.5 years) undergoing clam ileocystoplasty.
- Indications included neuropathic bladder, epispadias-exstrophy complex, and posterior urethral valves.
- Outcomes measured included bladder capacity, storage pressures, hydroureteronephrosis, infections, and complications.
Main Results:
- All patients achieved satisfactory bladder capacity at safe storage pressures (< 20 cm saline).
- Hydroureteronephrosis improved in 91.7% of moieties, with no upper tract deterioration.
- Postoperative symptomatic urinary tract infections decreased significantly.
- Seven patients (17.9%) experienced 10 complications, including 4 cases (10.3%) of augmented bladder rupture.
Conclusions:
- Clam ileocystoplasty is effective in achieving adequate bladder capacity and improving upper tract status in children.
- While generally safe, potential complications, notably bladder rupture, require careful consideration and monitoring.
Abstract:
From 1987 to 1992, bladder augmentation using clam ileocystoplasty was performed in 39 children 1.5-17.5 years old (mean age 9.7 years). Indications for augmentation included neuropathic bladder, epispadias-exstrophy complex and posterior urethral valves. A satisfactory bladder capacity at safe storage pressures of < 20 cm saline was achieved in all patients. Hydroureteronephrosis resolved or improved in 33 of the 36 moieties (91.7%). No patient showed biochemical or radiological deterioration of the upper tracts. The incidence of symptomatic urinary tract infection fell significantly postoperatively. Seven patients (17.9%) developed a total of 10 complications, with rupture of the augmented bladder occurring in 4 patients (10.3%).