TITLE:
Reconstructive Surgery in the Lower Urinary Tract in Children: Can the Complication Rate Be Reduced?
AUTHORS:
Sara Carlsson, Maryam Moussavi, Ulla Sillen, Gundela Holmdahl, Kate Abrahamsson
KEYWORDS:
Children; Complications; Augmentation; CIC-Channel; Bladder Neck Plasty
JOURNAL NAME:
Open Journal of Urology,
Vol.4 No.3,
March
11,
2014
ABSTRACT: Objective: Reconstructive surgery of the lower urinary
tract in children is reported with a high
complication rate. The aim was to evaluate the complication rate at our
institution. Material and methods: Between 2000 and 2010, 41 boys and 19 girls
were consecutively operated on with augmentation with ileum (45), alternative CIC-channel (57) and bladder neck
plasty (42) in isolation or as combined procedures in individuals with
neurogenic bladder dysfunction NBD (42), bladder exstrophy-epispadias complex
BEEC (13), isolated epispadias IE (2) and posterior urethral valves, PUV (3).
Median age at surgery was 11 years (range 1.3 -21) and median follow-up time 7 years (1 -10). Complications were consecutively observed
at follow-up according to a structured protocol. As first line care, specially
trained nurses followed the patients and daily bladder irrigation was included
in the CIC follow-up regimen. Results: In individuals with augmentation with
ileum, of which all but one performed CIC through an alternative channel, there
were stones reported in 3/45 (7%), perforation in 2/45 (4%), reoperation of CIC
channel in 5/57 (9%), bowel obstruction in 3/56 (5%) and rupture of BNP in 3/39
(8%). Re-augmentation was not needed and malignancy not found. No significant
difference was seen between patients with NBD and BEEC/IE. Conclusion: Complication
rates were among the lowest reported for stones, perforation and reoperations
of CIC channels and were average for bowel obstruction. Bladder stones and
perforation were seen in individuals with bad compliance to recommended CIC-and irrigation regimens.