Summary
Background
Initial management of pediatric patients with neurogenic bladder is focused on clean
intermittent catheterization and medical therapies. Those with more hostile or small
capacity bladders require surgical intervention including bladder augmentation that
can result in significant clinical sequelae. This study examines a rarely described
approach wherein the bladder reconstruction is extraperitonealized by bringing bowel
segments through a peritoneal window and then closed.
Objective
The aim of this study was to determine if the rate of bladder rupture and subsequent
morbidity differed between patients who have undergone an intraperitoneal versus extraperitoneal
bladder augmentation. We hypothesized that an extraperitoneal approach reduced the
risk of intraperitoneal bladder perforation, downstream Intensive Care Unit (ICU)
admission, small bowel obstruction (SBO) requiring exploratory laparotomy, and ventriculoperitoneal
(VP) shunt-related difficulties as compared to the standard intraperitoneal technique.
Methods
A retrospective chart review was conducted to assess surgical approach and outcomes
in patients who underwent bladder augmentation performed between January 2009 and
June 2021. Patients were identified through an existing database and manual chart
review was conducted to extract data through imaging studies, operative notes, and
clinical documentation. The primary outcome was bladder perforation. Secondary outcomes
were ICU admission, exploratory laparotomy, and VP shunt externalization, infection,
or revision for any cause. Nonparametric statistical analyses were performed.
Results
A total of 111 patients underwent bladder augmentation with 37 intraperitoneal and
74 extraperitoneal procedures. Median follow up was 5.8 years [IQR 3.0–8.6 years]
and did not vary between groups (P = 0.67). Only one patient was found to have a bladder perforation in the intraperitoneal
group (log-rank P = 0.154). There were no significant differences in time to post-augmentation ICU
admission, exploratory laparotomy, or VP shunt events between the two groups (log-rank
P = 0.294, log-rank P = 0.832, and log-rank P = 0.237, respectively). Furthermore, a Kaplan–Meier analysis assessing time to composite
complication demonstrated no significant difference between the two techniques (log-rank
P = 0.236).
Discussion
This study provides important data comparing the rate of bladder perforation and subsequent
morbidity between intraperitoneal and extraperitoneal bladder augmentation. As expected,
with a complex procedure, both groups suffered complications, but these data showed
no difference between the two procedures. Rates of prior (abdominal) surgery may influence
the decision to perform this procedure extraperitoneal.
Conclusions
Graphical AbstractKaplan–Meier curve of composite postoperative event-free status over time in the two
cohorts of patients. Composite event is defined as any of bladder perforation, exploratory
laparotomy, intensive care unit admission or ventriculoperitoneal shunt infection,
externalization, or revision. There was no difference in event-free status between
the two groups by log-rank testing.
Keywords
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References
- Medical management of neurogenic bladder for children and adults: a review.Top Spinal Cord Inj Rehabil. 2019; 25: 195-204https://doi.org/10.1310/sci2503-195
- Summary of European association of Urology (EAU) guidelines on neuro-urology.Eur Urol. 2016 Feb; 69 (Epub 2015 Aug 22. PMID: 26304502): 324-333https://doi.org/10.1016/j.eururo.2015.07.071
- Augmentation cystoplasty in neurogenic bladder.Investigative and clinical urology. 2016; 57: 316-323https://doi.org/10.4111/icu.2016.57.5.316
- Clam ileocystoplasty.Br J Urol. 1991; 68: 487-489https://doi.org/10.1111/j.1464-410x.1991.tb15391.x
- Comparison of extraperitoneal and intraperitoneal augmentation enterocystoplasty for neurogenic bladder in spinal cord injury patients.World J Urol. 2009; 27: 63-68https://doi.org/10.1007/s00345-008-0351-3
- The past, present and future of augmentation cystoplasty.BJU Int. 2012 May; 109 (Epub 2011 Nov 25. PMID: 22117733): 1280-1293https://doi.org/10.1111/j.1464-410X.2011.10650.x
- Risk factors for spontaneous bladder Perforation after augmentation cystoplasty.Urology. 2003 Oct; 62 (PMID: 14550454): 737-741https://doi.org/10.1016/s0090-4295(03)00678-2
- Mortality after bladder augmentation in children with spina bifida.J Urol. 2015 Feb; 193 (Epub 2014 Jul 27. PMID: 25072178): 643-648https://doi.org/10.1016/j.juro.2014.07.101
- Bladder rupture.in: StatPearls [internet]. Treasure island (FL). StatPearls Publishing, 2021 Sep. 17 (2022 Jan–. PMID: 29262195)
- What is the need for additional bladder surgery after bladder augmentation in childhood?.J Urol. 2006; 176: 1801-1805https://doi.org/10.1016/j.juro.2006.03.126
- Long-term risks of bladder augmentation in pediatric patients.Curr Opin Urol. 2008; 18: 408-412https://doi.org/10.1097/MOU.0b013e328300587c
- Anterior flap extraperitoneal cystoplasty.J Urol. 1997; 157: 2095-2098
- Surgical complications of bladder augmentation: comparison between various enterocystoplasties in 133 patients.Urology. 2000 Jan; 55 (PMID: 10654908): 123-128https://doi.org/10.1016/s0090-4295(99)00443-4
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.PLoS Med. 2007 Oct 16; 4 (PMID: 17941714; PMCID: PMC2020495): e296https://doi.org/10.1371/journal.pmed.0040296
- Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder.Urology. 1998 Oct; 52 (PMID: 9763092): 672-678https://doi.org/10.1016/s0090-4295(98)00220-9
- Augmentation cystoplasty: urodynamic and metabolic outcomes at 10-year follow-up.Int J Urol. 2015 Dec; 22 (Epub 2015 Sep 22. PMID: 26391472): 1149-1154https://doi.org/10.1111/iju.12943
- Augmentation cystoplasty in the patient with neurogenic bladder.World J Urol. 2020 Dec; 38 (Epub 2019 Sep 11. PMID: 31511969): 3035-3046https://doi.org/10.1007/s00345-019-02919-z
- Outcome of augmentation cystoplasty and bladder substitution in a pediatric age group.Eur J Pediatr Surg. 2011 Mar; 21 (Epub 2010 Nov 4. PMID: 21053159): 116-119https://doi.org/10.1055/s-0030-1267223
- Bladder perforation in augmentation cystoplasty during urodynamic investigation: a case report and review of the literature.J Pediatr Urol. 2013 Apr; 9 (Epub 2012 Dec 11. PMID: 23238439): e102-e106https://doi.org/10.1016/j.jpurol.2012.11.013
- Additional surgeries after bladder augmentation in patients with spina bifida in the 21st century.J Urol. 2020 Jun; 203 (Epub 2020 Jan 17. PMID: 31951496): 1207-1213https://doi.org/10.1097/JU.0000000000000751
Article info
Publication history
Published online: December 11, 2022
Accepted:
December 6,
2022
Received in revised form:
November 22,
2022
Received:
May 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
