What is the Need for Additional Bladder Surgery After Bladder Augmentation in Childhood?

Abstract

Bladder augmentation provides immeasurable improvements in quality of life but it requires lifelong dedication from the patient, family and health care providers. While the requirements for additional surgery are not trivial, 66% of our patients have not required any further surgery in the augmented bladder.

Race and 30-Day Morbidity in Pediatric Urologic Surgery

“…32,33 Similarly, 1 of the largest studies of enterocystoplasty outcomes is a single-institution retrospective analysis of 500 consecutive cases that demonstrated 34% reoperation rate but did not assess for symptomatic UTI or SSI after initial surgery. 34 By comparison, after including transfusion, reoperation, UTI, and SSI among our complications, we found a 23% overall 30-day complication rate among all bladder procedures assessed in our study. This difference in complication rates helps demonstrate that accurate portrayals of perioperative risks, which are essential to patient counseling, may be limited without the use of uniform measures of complications.…”

Neuropathic bladders: Investigation and treatment through their lifetime

“…In a large series from Indiana, perforations occurred in 8.6% of patients, with one death. 11,30 Due to the critically ill presentation of most patients, immediate laparotomy with peritoneal washout, primary closure, and maximal drainage is required. If the patient is not ill and has a small, contained leak, conservative management with percutaneous drains and aggressive bladder drainage can be successful.…”

Highlights of the University of Toronto Urology Update 2014

“…58 In the largest series published to date (n = 500, Indianapolis, IN) following children post-bladder augmentation, 30% of these children experienced complications requiring surgery. 59 While the majority of these involved removal of bladder or renal stones, a substantial proportion were to address more serious complications, such as bowel obstruction, bladder perforation, and transitional cell carcinoma (TCC) of the bladder. Metabolic complications (e.g., B12 deficiency) are also common.…”

“…Among the 500 patients in the Indianapolis cohort, 3.2% (16 patients) experienced bowel obstruction. 59 Most of these were subsequent to gastric augmentation, which is no longer a preferred surgical option. The mean time to this complication was 51 months post-augmentation.…”

“…59 These perforations were almost universally symptomatic, with variable presenting complaints (e.g., abdominal pain, poor feeding, vomiting). Importantly, all patients had increased fluid on computed tomographic cystogram; this imaging modality is thought to be the best method of identifying these perforations.…”