Bladder Re-augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention
| Autor: | John Jayman, John P. Gearhart, Karl Benz, Mahir Maruf, Timothy Baumgartner, Karen M. Doersch, Matthew Kasprenski |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Adolescent Colon Urology Urinary Bladder 030232 urology & nephrology Bladder capacity Ileum 03 medical and health sciences 0302 clinical medicine Postoperative Complications Risk Factors Medicine Humans In patient Child business.industry Bladder Exstrophy Sigmoid colon Small bladder Organ Size Plastic Surgery Procedures medicine.disease Surgery Bladder exstrophy Urethrocutaneous fistula medicine.anatomical_structure 030220 oncology & carcinogenesis Child Preschool Cohort Female business |
| Zdroj: | Urology. 115 |
| ISSN: | 1527-9995 |
| Popis: | Objective To characterize the causes of re-augmentation in patients with classic bladder exstrophy (CBE). Methods A prospectively maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for patients with CBE who underwent more than 1 augmentation cystoplasty (AC) procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated. Results A total of 166 patients with CBE underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17 of 17), inadequate bladder necks (8 of 17), failed rattail augmentation (2 of 17), stomal incontinence (1 of 17), a urethrocutaneous fistula (1 of 17), and an hourglass augmentation (1 of 17). Of note, 5 of the 17 patients (29%) had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), whereas the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm (standard deviation [SD] 3.6) compared with 19 cm (SD 5.0) during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm (SD 4). The mean re-augmentation preoperative bladder capacity of 100 mL (SD 60) immediately increased after re-augmentation to 180.8 mL (SD 56.4) (P = .0001). Conclusion Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure. |
| Databáze: | OpenAIRE |
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