Pediatric bladder augmentation – Panacea or Pandora’s box?

Abstract

Introduction: Bladder augmentation is a surgery that can increase bladder capacity and compliance. The objective of this study was to provide a longitudinal review of pediatric bladder augmentation at a tertiary Canadian center.
 Methods: A retrospective review was performed on patients who underwent bladder augmentation at a tertiary pediatric hospital between 1986 and 2014. The primary objective was short- and long-term complications of augmentation. Secondary objectives were to review number of augmentation procedures performed over time and the utility of routine postoperative cystograms.
 Results: A total of 56 procedures were performed on 54 patients (28 males, 26 females) of mean age 10 years (standard deviation [SD] 5) and mean followup eight years (SD 5). The most common bowel segment used was ileum (87.5%). Twenty-eight patients (50%) received catheterizable channels. Overall complication rate was 15%, and the most common complications were urinary tract infections (68.5%), worsening hydronephrosis (14.8%), bladder stone formation (14%), and hematuria (13%). In total, 19 of 54 (35.2%) patients returned to the operating room. The incidence of bladder perforation was 3.6%. Complications with the catheterizable channel occurred in 13 of 28 (46.4%), of which 10 were related to stomal stenosis. Forty patients had postoperative cystograms and extravasation was seen in three (7.5%). There was no malignancy during the followup. Only four augmentations were performed from 2008–2014.
 Conclusions: Bladder augmentation likely represents a safe surgical treatment option. Extravasation on postoperative cystogram was uncommon and thus it may not be indicated routinely. The number of augmentation procedures performed has declined in recent years.

Stone formation in the augmented urinary bladder in childhood: the current state of the problem

“…Група канадських авторів описали власний досвід виконання аугментаційних цистопластик (56 процедур за 28 років), причому у 87,5% це була здухвинна кишка для резервуара. У 14,8% відмічалося формування конкре-ментів [24]. T. E. Helmy та співавт.…”