Summary
Purpose
The need for mechanical inpatient bowel preparation (IBP) in reconstructive pediatric
urology has come under scrutiny, secondary to literature demonstrating little benefit
regarding outcomes. Starting in 2013, a majority of patients undergoing reconstructive
procedures at our institution no longer underwent IBP. We hypothesized that outpatient
bowel preparation (OBP) would reduce length of stay (LOS) without increasing postoperative
complications after appendicovesicostomy surgery.
Materials and methods
An institutional database of patients undergoing lower urinary tract reconstruction
between May 2010 and December 2014 was reviewed. Starting in 2013, a departmental
decision was made to replace IBP with OBP. Patients undergoing an augmentation cystoplasty
or continent ileovesicostomy were excluded because of insufficient numbers undergoing
OBP. Patients undergoing IBP were admitted 1 day prior to surgery and received polyethylene
glycol/electrolyte solution. A personalized preoperative OBP was introduced in 2013.
Cost data were obtained from the Pediatric Health Information System.
Results
Sixty-seven patients met the inclusion criteria, with 30 (44.8%) undergoing IBP. There
were no differences with respect to gender, age, presence of ventriculoperitoneal
shunt, body mass index, glomerular filtration rate, preoperative diagnosis, operative
time, and prior or simultaneous associated surgeries (p ≥ 0.07). Patients undergoing an IBP had a longer median LOS (7 vs. 5 days, p = 0.0002) and a higher median cost (US$4,288, p = 0.01). Postoperative complications in both groups were uncommon and were classified
as Clavien–Dindo grade 1–2, with no statistical difference (IBP 20.0% vs. OBP 5.4%,
p = 0.13). No serious postoperative complication occurred, such as a dehiscence, bowel
obstruction, or shunt infection.
Discussion
This is the first analysis of hospitalization costs and IBP, showing a higher median
cost of US$4288 compared with OBP. The LOS was shorter with an OBP (figure), similar
to a previous report. Similar complication rates between the groups add to the growing
body of literature that avoidance of IBP is safe in pediatric lower urinary tract
reconstruction. Being a retrospective review of a practice change, differences in
care that influenced cost and LOS may be missing. Also, as the surgeons do not know
if a usable appendix is initially present, our data may not extrapolate to all patients.
Despite these potential limitations, our data support the safety of utilizing OBP
in patients with a high likelihood of a usable appendix, including those undergoing
a synchronous Malone antegrade continence enema via a split-appendix technique.
Conclusion

Graphical AbstractLength of hospital admission for children and adolescents undergoing appendicovesicostomy.
Keywords
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Article info
Publication history
Published online: August 26, 2017
Accepted:
July 8,
2017
Received:
May 23,
2017
Identification
Copyright
© 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.