A therapeutic method for failed bladder augmentation in children: re‐augmentation

Abstract

OBJECTIVE To investigate the causes leading to the deterioration of previously successful bladder augmentation and to evaluate the efficacy of re‐augmentation. PATIENTS AND METHODS Between 1988 and 2004, 136 bladder augmentations were performed in two paediatric urological units in Hungary and Turkey. Re‐augmentation was necessary in two patients after colocystoplasty and in three after gastrocystoplasty. A secondary augmentation was not required in any patients after ileocystoplasty. The clinical data of these five patients were evaluated. RESULTS On the basis of the clinical signs and urodynamic studies, re‐augmentation was performed 2–7 years after the initial augmentation cystoplasties. Anticholinergic therapy given before re‐augmentation did not improve bladder capacity, intravesical pressure and/or bladder compliance. An ileal or sigmoid segment was used for the secondary augmentation. After re‐augmentation, all five patients became continent, and showed marked improvement in their urodynamic parameters at a mean (range) follow‐up of 6.8 (2–10) years. CONCLUSION A decreased bladder capacity and/or compliance and increased bladder pressure after successful augmentation cystoplasty might be the result of: (i) impairment of the blood supply to the large bowel or gastric segment used for augmentation; or (ii) bowel mass contractions. Ileocystoplasty seems to be the ‘first‐line’ of choice for primary augmentation. Re‐augmentation with a bowel segment is a suitable treatment if conservative treatment fails. Regular urodynamic investigations are needed for early detection of malfunction of the augmented bladder, and advising therapy.

Complications after bladder augmentation or substitution in children: a prospective study of 86 patients

“…Despite the many complications encountered in patients with augmentation cystoplasty, only a few studies deal with the reasons for its failure and subsequent treatment in children [26,27]. Decreased bladder compliance and capacity, increased intravesical pressure, worsening of the kidney morphology and function and anticholinergic drug intolerance are the main indications for secondary augmentation.…”

Evaluation and Management of Failed Bladder Reconstructions

“…In a larger series, the cumulative incidence was 13.4 % after 10 years [16]. Ileocystoplasty appears to have the lowest failure rate, while gastrocystoplasty failure rates approach 10 % [24][25][26]. Evaluation with urodynamics, often employed with fluoroscopic imaging, is necessary to confirm failed augmentation [27].…”

“…Rates of failed augmentation, marked by a loss of either capacity or compliance, vary across the relevant literature but are generally low. One series reported a 3.7 % failure rate an average of 4.2 years following surgery [24]. In a larger series, the cumulative incidence was 13.4 % after 10 years [16].…”

“…Evaluation with urodynamics, often employed with fluoroscopic imaging, is necessary to confirm failed augmentation [27]. The most durable solution is repeat augmentation; however, more conservative approaches may be considered prior to undertaking another major operation [24]. Anticholinergic therapy may treat both detrusor overactivity and increased contractility of the anastomosed bowel segment [27].…”

Transitional care in pediatric urology

“…The re-augmentation risk at 10 years post initial augmentation has been reported as 3.7-5.9%. 8 A large clinical series from Indiana University documented a 34% risk of further operative procedures after augmentation. Approximately 9% of children required a laparotomy for bowel obstruction.…”