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

Malhotra. Sumeeta J.Flood . David A. Michael J. Bloom Neurology and Urodynamics 14:297 – 309 (1995) .Long Terms Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology Huhg D. Ritchey. Helen O’Connell.

Orsolya Erdei.1464-410X. 2010 BJU INTERNATIONAL | doi:10.1111/j. Attila M.09862.Complications after bladder augmentation or substitution in children: a prospective study of 86 patients Zoltan Kispal. Daniel Balogh*.x .2010. Daniel Kehl*. Zsolt Juhasz.

Vol. enterocystoplasty is unfortunately still the gold standard. Iymiser Ure. such as metabolic disorders. jody Nuininga. enteric fistulas and potencial for malignancy. Robert P. Although bladder reconstruction with GI segmentes can be associated with multiple complications. Bladder augmentation: Review of the literatura and recent advances Serhat Gurocak.23 Issue 4.457 .E De Gier Indian Journal of Urology 2007. mucus production. Page: 452 . calculus formation.

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COMPLICATIONS AFTER BLADDER AUGMENTATION Complications after bladder augmentation or substitution in children: a prospective study of 86 patients Zoltan Kispal.x .1464-410X. Daniel Balogh*. Zsolt Juhasz. Daniel Kehl*.2010. 2010 BJU INTERNATIONAL | doi:10. Attila M. Orsolya Erdei.1111/j.09862.

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 .

 Shekarriz’s study  Husmann and Cain  Peter Metcalfe 36% 39% 48% 34 % Bladder Augmentation Complications in a Pediatric Poblation Peter Metcalfe at el.09862. 2010 BJU INTERNATIONAL | doi:10. Daniel Kehl*.2010.x  Previous series:  Hersehorn et al. Zsolt Juhasz.8:152 . Attila M.156 .1111/j. Orsolya Erdei. Current Urology Reports 2007.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*.1464-410X.

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%) .STONE FORMATION (13 – 23%)  Is the most common long-term complication 13 – 23% (Augmentation Cystoplasty Treatment .Pravin K Rao MD and collegues.

175:1466–70. 27: 69–73 .BLADDER PERFORATION (6 – 13%) • Perhaps the most disturbing complication • Aetiologic factors: <%: >%: abdominal and catheter trauma ischaemia secondary to high intravesical pressure. Pediatric enterocystoplasty: W. Metcalfe P. Kaefer M. Kurzrock EA. J Urol 2009. discussion 470–1. Casale A. J Urol 2006. Long-term complications and controversies. 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.

1111/j. Zsolt Juhasz. Orsolya Erdei. Daniel Balogh*. 2010 BJU INTERNATIONAL | doi:10. Attila M. Daniel Kehl*.x .09862.2010.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.1464-410X. Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal.

x .1111/j.09862. increased intravesical pressure  Worsening of the kidney morphology and function and anticholinergic drug intolerance are the main indications for secondary augmentation. Decreased bladder compliance and capacity. Orsolya Erdei.1464-410X. 2010 BJU INTERNATIONAL | doi:10. Zsolt Juhasz. Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal. Daniel Balogh*. Daniel Kehl*.2010. Attila M.

BOWELL OBSTRUCTION (3 – 5%)  Postoperative bowel obstruccion is uncommon after aumentation cistoplasty : aproximately 3%. King 1987. Hollensbe et al 1992. Mitchell and Pizer 1987. Rink et al 1995)  The incidence of BO is low regardless tha GI segment used  Factors that avoid obstruction . (Gearhart et al 1986.

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 .

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. Cur Opin Urol 2008. 18: 408–12  Average presentation time: 15 – 25 years  Gastrocystoplasty  Spina bifida . Austin JC. Urinary Tract Infection  Persisten bacteriuria is common after intestinal cystoplasty  Treatment only in significant symptoms .

1464-410X. Orsolya Erdei.09862. Daniel Balogh*. 2010 BJU INTERNATIONAL | doi:10. Attila M. Daniel Kehl*. Zsolt Juhasz.2010.Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal.1111/j.x .

Zsolt Juhasz.1111/j.1464-410X.Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal.09862. Attila M. Orsolya Erdei. Daniel Balogh*.x . Daniel Kehl*.2010. 2010 BJU INTERNATIONAL | doi:10.

Complications after bladder augentation or substitution in children: a prospective study of 86 patients Zoltan Kispal.x . Zsolt Juhasz. 2010 BJU INTERNATIONAL | doi:10.001) and required more post-operative interventions ( P < 0.09862.1111/j.05). Daniel Kehl*. Daniel Balogh*. Orsolya Erdei.1464-410X.05) than patients with gastrocystoplasty and ileocystoplasty. Attila M. especially more stone formation rate ( P < 0.2010. Patients with colocystoplasty had significantly more complications (P < 0.

1464-410X. Magyarlaki T. J Urol 2006.x Long Terms Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology. Malhotra. 168 : 698– 701. Zoltan Kispal. Zsolt Juhasz. Ritchey.2010. Pinter AB. Lenart I. Sumeeta J. 2010 BJU INTERNATIONAL | doi:10.1111/j. Ped Surg Int 2009. discussion 701 Long term risks of bladder augmentation in pediatric patients. J Urol 2002. Metcalfe P.09862.Flood . Cur Opin Urol 2008. Farkas A. Huhg D. Bloom Neurology and Urodynamics 14:297 – 309 (1995) Quality of life: urinary bladder augmentation orsubstitution in children. Kaefer M. Daniel Balogh*. Michael J.BIBLIOGRAPHY Complications after bladder augentation or substitution in children: a prospective study of 86 patients. David A. Farkas A. Attila M. Vajda P. Pinter AB. Kispal Z. discussion 1470–1 . Vastyan AM. 175: 1466–70. Daniel Kehl*. Helen O’Connell. Vajda P. 25 : 195–201 Histological findings after colocystoplasty and gastrocystoplasty. Vastyan AM. 18: 408–12 Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. Casale A. Kaiser L. Austin JC. Orsolya Erdei.