Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

Abstract

The present review provides clinical insights and makes recommendations regarding patient management garnered by the long-term follow up of patients undergoing enteric bladder augmentation for the management of congenital anomalies. A prospectively maintained database on 385 patients that have experienced an enteric bladder augmentation, using either the ileum or colon, was reviewed. Evaluations included methods used to prevent bladder calculi formation and recurrence, the incidence and etiology of renal calculi development, the incidence and treatment of vitamin B 12 deficiency, and the complications and need for surgical revisions for continent catheterizable stomas. A significantly increased risk for continent catheterizable stomal complications occurred after Monti-Yang tube formation, 70% (21/ 30 patients), compared with appendicovesicostomy, 41% (27/66 patients), P = 0.008. Both procedures had significantly more complications than continent catheterizable stomas using tapered ileum with a reinforced ileal-cecal valve, 21% (13/63 patients), P < 0.0001 and P < 0.013, respectively. Approximately 50% of the patient population developed a body mass index ≥30 during adulthood. The onset of obesity resulted in significantly more complications developing in patients with a Monti-Yang tube (87%; 13/ 15 patients) or appendicovesicostomy (55%; 18/33 patients) compared with a tapered ileum with a reinforced ileal-cecal valve (27%, 8/30 patients), P < 0.00015 and P < 0.025, respectively, with a median follow-up interval of 16 years, range 10-25 years. Long-term follow-up evaluations on patients undergoing an enteric bladder augmentation are necessary to prevent the long-term sequela of this procedure. The key to improving patient prognosis is the nutritional management of the patient as they mature, especially if a continent abdominal stoma is going to be carried out.

Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10‐year period: A Neurogenic Bladder Research Group study

“…A study of pediatric patients who had undergone augmentation cystoplasty with a catheterizable channel showed that complications related to the channel were dependent on the type of channel. 16 Rates of channel abandonment and revisions were highest in patients with a reconfigured ileum (Monti), lower in patients with an appendicovesicostomy (Mitrofanoff), and lowest in patients with a tapered ileum and reinforced ileocecal valve (CCIC). 16 In a similar study, O'Connor et al 17 evaluated the outcomes of different types of catheterizable channels and found that 39% of patients underwent a major channel revision during a median follow-up period of 60 months.…”

“…16 Rates of channel abandonment and revisions were highest in patients with a reconfigured ileum (Monti), lower in patients with an appendicovesicostomy (Mitrofanoff), and lowest in patients with a tapered ileum and reinforced ileocecal valve (CCIC). 16 In a similar study, O'Connor et al 17 evaluated the outcomes of different types of catheterizable channels and found that 39% of patients underwent a major channel revision during a median follow-up period of 60 months. The channel incontinence and revision rates were higher in the ileal group than in the appendiceal group, though most of the ileal group had Monti channels and none of them underwent a CCIC.…”

Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction

“…After performing a Kock pouch, the incidence rises to more than 40% (108). Regular and generous irrigation of the pouch can probably reduce the rate of stones (109). The third most common pouch-related complication is the development of a stenosis at the ureteral re-implantation site.…”

Pediatric bladder augmentation – Panacea or Pandora’s box?

“…Common post-operative complications include bladder stones, bladder rupture, renal deterioration, metabolic abnormalities, and malignancy. [3][4][5][6][7][8][9][10] Due to a decreased incidence of associated congenital disorders in the western world as well as improvements in early detection and treatment of patients with neurogenic bladders, the rates of augmentation cystoplasty performed appear to be declining in both the United Kingdom and the United States. 3,4 To our knowledge there have been no Canadian series reporting on long-term outcomes of pediatric bladder augmentation.…”