Bilateral ureteral reimplantation at complete primary repair of exstrophy: Post-operative outcomes.

Autor: Jarosz SL; Department of Urology, Pediatric Urology Division, Medical College of Wisconsin, Children's Wisconsin, 8915 W. Connell Court, Milwaukee, WI, 53226, USA., Weaver JK; Department of Urology, Pediatric Urology Division, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA., Weiss DA; Department of Urology, Pediatric Urology Division, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA., Borer JG; Department of Urology, Pediatric Urology Division, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA, 02115, USA., Kryger JV; Department of Urology, Pediatric Urology Division, Medical College of Wisconsin, Children's Wisconsin, 8915 W. Connell Court, Milwaukee, WI, 53226, USA., Canning DA; Department of Urology, Pediatric Urology Division, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA., Groth TW; Department of Urology, Pediatric Urology Division, Medical College of Wisconsin, Children's Wisconsin, 8915 W. Connell Court, Milwaukee, WI, 53226, USA., Lee T; Department of Urology, Pediatric Urology Division, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA, 02115, USA., Shukla AR; Department of Urology, Pediatric Urology Division, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA., Mitchell ME; Department of Urology, Pediatric Urology Division, Medical College of Wisconsin, Children's Wisconsin, 8915 W. Connell Court, Milwaukee, WI, 53226, USA., Roth EB; Department of Urology, Pediatric Urology Division, Medical College of Wisconsin, Children's Wisconsin, 8915 W. Connell Court, Milwaukee, WI, 53226, USA. Electronic address: ERoth@chw.org.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2022 Feb; Vol. 18 (1), pp. 37.e1-37.e5. Date of Electronic Publication: 2021 Oct 18.
DOI: 10.1016/j.jpurol.2021.10.012
Abstrakt: Background and Study Objective: The value of bilateral ureteral reimplant (BUR) at the time of complete primary repair of bladder exstrophy (CPRE) has been suggested, however, outcomes are poorly characterized in current medical literature. We hypothesize that BUR at time of CPRE will decrease the rate of recurrent pyelonephritis, post-operative vesicoureteral reflux (VUR), and the need for subsequent ureteral surgery.
Study Design: We analyzed 64 consecutive patients with a diagnosis of classic bladder exstrophy (BE) who underwent CPRE at three institutions from 2013 to 2019.15 patients underwent cephalotrigonal BUR-CPRE and 49 patients underwent CPRE alone. Our primary outcome was >1 episode of pyelonephritis as documented in the medical record. Secondary outcomes were persistent vesicoureteral reflux (VUR), with a sub-analysis of number of refluxing renal units and presence of dilating VUR, and the need for subsequent ureteral surgery. Descriptive statistics in addition to standard, two tailed univariate statistics, were used to compare the groups where appropriate.
Results: BUR-CPRE was associated with a significant decrease in the rates of post-operative VUR, number of refluxing renal units, and need for subsequent ureteral surgery (p = 0.002, p = 0.001, and p = 0.048 respectively). There was a reduction in the rates of recurrent pyelonephritis and dilating reflux in patients undergoing BUR-CPRE, though it did not reach significance. Female gender was significantly associated with recurrent pyelonephritis regardless of BUR-CPRE status (p = 0.005). There were no reports of distal ureteral obstruction or other complications following BUR-CPRE. The mean post-operative follow up for the BUR-CPRE group was 46.33 (10.26) months vs. 53.76 (26.05) months for CPRE (p = 0.11).
Discussion: Recurrent pyelonephritis following bladder closure in patients with BE is a well-documented surgical complication, with centers performing CPRE reporting rates of post-operative pyelonephritis from 22 to 50%. Our series demonstrates similar efficacy of BUR-CPRE compared to other contemporary series and provides additional detail about need for subsequent ureteral surgeries and increased long term follow-up of these complex patients. Limitations of the study include male predominance of the cohort and lack of randomization of BUR-CPRE.
Conclusions: BUR-CPRE decreases postoperative VUR and the need for additional ureteral surgery in select BE patients; it should be considered when technically feasible. While results continue to suggest a trend toward decreased recurrent pyelonephritis and dilating reflux, further longitudinal follow-up in our cohort will be needed.
Competing Interests: Conflicts of interest None.
(Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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