A study reflecting experiences, observations regarding the problems and complications and drawn lessons regarding the bladder augmentations in an educational clinic
Emil Mammadov1, Rahşan Özcan2, Şenol Emre2, Mehmet Eliçevik2, Güner Kaya3, Çiğdem Tütüncü3, Pınar Kendigelen3, Sergülen Dervişoğlu4, Yunus Söylet2, Nur Danişmend2, Haluk Emir2, S. N. Cenk Büyükünal2
1Yakın Doğu Üniversitesi Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Lefkoşa
2İ.Ü., Cerrahpaşa Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Çocuk Ürolojisi Bilim Dalı, İstanbul
3İ.Ü., Cerrahpaşa Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul
4İ.Ü., Cerrahpaşa Tıp Fakültesi,Patoloji Anabilim Dalı, İstanbul
Keywords: Bladder augmentation, pediatric surgery, pediatric urology, complications
Abstract
Aim: To analyze the cases with bladder augmentation performed in our clinic in the period of 1987-2011, to determine the early and late problems related to the procedure and to state the experiences and learned lessons regarding this condition.
Material and Methods: The files of 77 patients were included in the study and analyzed retropectively. Laboratory tests, ultrasonography, renal scintigraphy, VCUG and urodinamy was performed in all patients in pre and postoperative period. Some patients required IVP and CT as diagnostic procedure. In the late follow up period extra investigations like weight-height measures, body mass index, blood biochemistry, renal ultasonography, direct urinary X-Ray and cystoscopy with biopsy and histopathologic examination was performed in 22 patients.
Results: Mean follow up was 11,4 years (r:4-23). There was a male predominance in the group (46 males/31 females). The diagnoses prior to procedure were bladder exstrophy (41), neurogenic bladder (34), traumatic bladder and urethral injury (2). Mean operation age was 8,5 years (r:1,5-23). Ileum was used as the patch in 53 (69%) patients. Mitrofanoff procedure was performed 61 cases (79%, appendix 77%, small intestine Monti 23%). Bladder neck reconstruction was required in 46 cases (69%). In 24/77 cases bladder neck closure was required to achieve complete urinary continence. As a result, complete urinary continence was achieved in 62/77 (79%) patients. Among 22 patients in the late follow up group, 2 patients had weight-height and body mass index problems and 3 patients had urea creatinine disturbances. Among 22 (19 endoscopic) biopsies; during the first 5 year period, extensive squamous metaplasia was detected in 1 patient; after the first 10 years, metaplastic changes in native bladder was detected in 2 patients.
Conclusion: Bladder augmentation is a complex procedure with side effects and complications arising in years. The urinary calculi formation and urinary incontinence continue to be the major problems despite all measures.