COMPLICATIONS AFTER BLADDER AUGMENTATION

MR1 VICTOR MANUEL MACHUCA C. UNMSM HNGAI

2010

 Bladder augmentation, also called augmentation

cystoplasty, is a surgical procedure indicate in adults and children who lack an adequate bladder capacity or detrusor compliance, wich can not be treated conservatively.

AugmentationCystoplastyTreatment
PravinK Rao MD and collegues.

Urology SurgeryJanuary 2009

Long Terms Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology
Huhg D.Flood , Sumeeta J. Malhotra, Helen OConnell, Michael J. Ritchey, David A. Bloom

Neurology and Urodynamics 14:297 309 (1995)

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

Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M.

2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

 Although bladder reconstruction with GI

segmentes can be associated with multiple complications, such as metabolic disorders, calculus formation, mucus production, enteric fistulas and potencial for malignancy, enterocystoplasty is unfortunately still the gold standard.

Bladder augmentation: Review of the literatura and recent advances

Serhat Gurocak, jody Nuininga, Iymiser Ure, Robert P.E De Gier

Indian Journal of Urology 2007. Vol.23 Issue 4. Page: 452 .457

COMPLICATIONS AFTER BLADDER AUGMENTATION

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

Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M.

2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

COMPLICATIONS AFTER BLADDER AUGMENTATION

It can be divided into two main categories:
1. Metabolic and histological complications:
o o o o o

Electrolyte and acid-base alteration Disturbances in bone metabolism Impaired linear growth Vitamin deficiencies Malignant histological alterations of the native bladder and the gastrointestinal

COMPLICATIONS AFTER BLADDER AUGMENTATION

2. Non-metabolic (mainly surgical)

complications:
o o o o o o o

Bowel obstruction Stone formation in the neobladder Perforation of the reservoir Vesico-urethral fistula Stoma complications Haematuria-dysuria syndrome (HDS) Re-augmentation

Rate Surgical Reintervention

43% of patients needed to undergo various

surgical reinterventions after augmentation

Complications after bladder augmentation or substitution in children: a prospective study of 86 patients
Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M.

2010

BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

Previous series:
Hersehorn et al. Shekarrizs study Husmann and Cain Peter Metcalfe

36% 39% 48% 34 %

Bladder Augmentation Complications in a Pediatric Poblation Peter Metcalfe at el.

Current Urology Reports 2007- 8:152 - 156

STONE FORMATION (13 23%)

Is the most common long-term complication 13 23%
(Augmentation Cystoplasty Treatment .Pravin K Rao MD and collegues. Urology Surgery January 2009)

Risk factor: Mucus production / Poor emptyng /

Bacteriuria / Permanent suture

RR:
Patients who void spontaneously
Those who catheterize urethrally Those with continent cutaneous stoma

LOWEST RR 5 RR 10 RR

>% Colocystoplasty
Regular daily prophylactic irrigation and Clean intermittent catheterization

RR 43 a 7%)

BLADDER PERFORATION (6 13%)

Perhaps the most disturbing complication Aetiologic factors:

<%: >%:

abdominal and catheter trauma ischaemia secondary to high intravesical pressure, chronic transmural infection and overdistension secondary to delayed catheterization

Symtomps Less Symtomps in patients with neurogenic dysfunction Diagnostic Treatment

Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. Metcalfe P, Casale A, Kaefer M. J Urol 2006; 175:146670; discussion 4701. Long-term complications and controversies. Kurzrock EA. Pediatric enterocystoplasty: W. J Urol 2009; 27: 6973

DECREASED BLADDER COMPLIANCE /CAPACITY REQUIRING RE-AUGMENTATION (2 13%)

Most problems with pressure after augmentation

cystoplasty occur from significant contractions apparently in the bowel segment.

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

Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M.

2010

BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

 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.

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

Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M.

2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

BOWELL OBSTRUCTION (3 5%)

Postoperative bowel obstruccion is uncommon after aumentation cistoplasty : aproximately 3%.
(Gearhart et al 1986, King 1987, Mitchell and Pizer 1987, Hollensbe et al 1992, Rink et al 1995)

The incidence of BO is low regardless tha GI

segment used
Factors that avoid obstruction

OTHERS COMPLICATIONS
Electrolyte and acid base alterations
Hyperchloremic metabolic acidosis Hypochloremic metabolic alkalosis

Impaired linear growth Vitamin B12 deficiency and megaloblastic

anemia
Hematuria Dysuria Syndrome

 Urinary Tract Infection

Persisten bacteriuria is common after intestinal

cystoplasty Treatment only in significant symptoms , fever and urea splitting organism in urine culture

Malignant histological alterations

Formation of malignancy is 5 7%
Long term risks of bladder augmentation in pediatric patients. Austin JC. Cur Opin Urol 2008; 18: 40812

Average presentation time: 15 25 years

Gastrocystoplasty Spina bifida

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

Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M. 2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M. 2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

 Patients with colocystoplasty had significantly

more complications (P < 0.05), especially more stone formation rate ( P < 0.001) and required more post-operative interventions ( P < 0.05) than patients with gastrocystoplasty and ileocystoplasty.

Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M. 2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

BIBLIOGRAPHY
Complications after bladder augentation or substitution in children: a prospective study of 86 patients. Zoltan Kispal, Daniel Balogh*, Orsolya Erdei, Daniel Kehl*, Zsolt Juhasz, Attila M. 2010 BJU INTERNATIONAL | doi:10.1111/j.1464-410X.2010.09862.x

Long Terms Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology. Huhg D.Flood , Sumeeta J. Malhotra, Helen OConnell, Michael J. Ritchey, David A. Bloom Neurology and Urodynamics 14:297 309 (1995)
Quality of life: urinary bladder augmentation orsubstitution in children. Vajda P, Kispal Z, Lenart I, Farkas A, Vastyan AM, Pinter AB. Ped Surg Int 2009; 25 : 195201 Histological findings after colocystoplasty and gastrocystoplasty. Vajda P, Kaiser L, Magyarlaki T, Farkas A, Vastyan AM, Pinter AB. J Urol 2002; 168 : 698 701; discussion 701 Long term risks of bladder augmentation in pediatric patients. Austin JC. Cur Opin Urol 2008; 18: 40812 Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. Metcalfe P, Casale A, Kaefer M. J Urol 2006; 175: 146670; discussion 14701