Advertisement

Retrospective analysis of bladder perforation risk in patients after augmentation cystoplasty using an extraperitoneal approach

  • Wesley T. Tran
    Correspondence
    Correspondence to: Wesley T. Tran, Children's Hospital Colorado, Medical Student, Department of Pediatric Urology, 13123 E. 16th Ave, Aurora, CO 80045, USA, Tel.: +720-777-1234
    Affiliations
    Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA

    Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Peter J. Boxley
    Affiliations
    Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA

    Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Duncan T. Wilcox
    Affiliations
    Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA

    Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Vijaya M. Vemulakonda
    Affiliations
    Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA

    Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Dan Wood
    Affiliations
    Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA

    Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Kyle O. Rove
    Affiliations
    Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA

    Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
Published:December 11, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.12.003

      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

      Figure 1
      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lucas E.
        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
        • Groen J.
        • Pannek J.
        • Castro Diaz D.
        • Del Popolo G.
        • Gross T.
        • Hamid R.
        • et al.
        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
        • Cetinel B.
        • Kocjancic E.
        • Demirdağ Ç.
        Augmentation cystoplasty in neurogenic bladder.
        Investigative and clinical urology. 2016; 57: 316-323https://doi.org/10.4111/icu.2016.57.5.316
        • George V.K.
        • Russell G.L.
        • Shutt A.
        • Gaches C.G.
        • Ashken M.H.
        Clam ileocystoplasty.
        Br J Urol. 1991; 68: 487-489https://doi.org/10.1111/j.1464-410x.1991.tb15391.x
        • Reyblat P.
        • Chan K.G.
        • Josephson D.Y.
        • Stein J.P.
        • Freeman J.A.
        • Grossfeld G.D.
        • et al.
        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
        • Biers S.M.
        • Venn S.N.
        • Greenwell T.J.
        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
        • DeFoor W.
        • Tackett L.
        • Minevich E.
        • Wacksman J.
        • Sheldon C.
        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
        • Szymanski K.M.
        • Misseri R.
        • Whittam B.
        • Adams C.M.
        • Kirkegaard J.
        • King S.
        • et al.
        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
        • Simon L.V.
        • Sajjad H.
        • Lopez R.A.
        • Burns B.
        Bladder rupture.
        in: StatPearls [internet]. Treasure island (FL). StatPearls Publishing, 2021 Sep. 17 (2022 Jan–. PMID: 29262195)
        • Metcalfe P.D.
        • Cain M.P.
        • Kaefer M.
        • Gilley D.A.
        • Meldrum K.K.
        • Misseri R.
        • et al.
        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
        • Austin J.C.
        Long-term risks of bladder augmentation in pediatric patients.
        Curr Opin Urol. 2008; 18: 408-412https://doi.org/10.1097/MOU.0b013e328300587c
        • Albo M.
        • Raz S.
        • Dupont M.C.
        Anterior flap extraperitoneal cystoplasty.
        J Urol. 1997; 157: 2095-2098
        • Shekarriz B.
        • Upadhyay J.
        • Demirbilek S.
        • Barthold J.S.
        • González R.
        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
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        • et al.
        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
        • Herschorn S.
        • Hewitt R.J.
        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
        • Cheng K.C.
        • Kan C.F.
        • Chu P.S.
        • Man C.W.
        • Wong B.T.
        • Ho L.Y.
        • et al.
        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
        • Cheng P.J.
        • Myers J.B.
        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
        • Obermayr F.
        • Szavay P.
        • Schaefer J.
        • Fuchs J.
        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
        • Ehdaie B.
        • Mason M.D.
        • Gray M.
        • Peters C.A.
        • Corbett S.T.
        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
        • Szymanski K.M.
        • Misseri R.
        • Whittam B.
        • Hollowell N.
        • Hardacker R.E.
        • Swenson C.R.
        • et al.
        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