Bladder Augmentation Expo

COMPLICATIONS AFTER BLADDER AUGMENTATION

MR1 VICTOR MANUEL MACHUCA C.

UNMSM – HNGAI

2010

Augmentation Cystoplasty TreatmentPravin K Rao MD and collegues.

Urology Surgery January 2009

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.

Long Terms Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology

Huhg D.Flood , Sumeeta J. Malhotra, Helen O’Connell, 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 advancesSerhat Gurocak, jody Nuininga, Iymiser Ure, Robert P.E De Gier

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

It can be divided into two main categories:

1. Metabolic and histological complications:

o Electrolyte and acid-base alteration o Disturbances in bone metabolismo Impaired linear growth o Vitamin deficiencies o Malignant histological alterations of the

native bladder and the gastrointestinal


2. Non-metabolic (mainly surgical) complications:

o Bowel obstructiono Stone formation in the neobladdero Perforation of the reservoiro Vesico-urethral fistulao Stoma complicationso Haematuria-dysuria syndrome (HDS)o Re-augmentation


Rate Surgical Reintervention 43% of patients needed to undergo

various surgical reinterventions after augmentation

Previous series: Hersehorn et al. 36% Shekarriz’s study 39% Husmann and Cain 48%

Peter Metcalfe 34 %




Bladder Augmentation Complications in a Pediatric PoblationPeter 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 LOWEST RR Those who catheterize urethrally 5 RR Those with continent cutaneous stoma 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; 175:1466–70; discussion 470–1.

Long-term complications and controversies. Kurzrock EA. Pediatric enterocystoplasty:

W. J Urol 2009; 27: 69–73

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



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.




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: 408–12

Average presentation time: 15 – 25 years Gastrocystoplasty Spina bifida

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




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



Long Terms Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology. Huhg D.Flood , Sumeeta J. Malhotra, Helen O’Connell, Michael J. Ritchey, David A. BloomNeurology 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 : 195–201

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: 408–12

Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk.Metcalfe P, Casale A, Kaefer M. J Urol 2006; 175: 1466–70; discussion 1470–1

Bladder Augmentation Expo

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