Transcript
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
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
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
COMPLICATIONS AFTER BLADDER AUGMENTATION
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
COMPLICATIONS AFTER BLADDER 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 %
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
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
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: 408–12
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 morestone 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
BIBLIOGRAPHYComplications 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 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
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