Bladder Re-augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention

• Published in: Urology (Ridgewood, N.J.) N.J.), 2018-05, Vol.115, p.157-161
• Main Authors: Benz, Karl S., Jayman, John, Doersch, Karen, Maruf, Mahir, Baumgartner, Timothy, Kasprenski, Matthew, Gearhart, John P.
• Format: Article
• Language: English
• Subjects: Adolescent; Bladder Exstrophy - surgery; Child; Child, Preschool; Colon - transplantation; Female; Humans; Ileum - transplantation; Male; Organ Size; Postoperative Complications - surgery; Reconstructive Surgical Procedures; Reoperation; Risk Factors; Urinary Bladder - pathology; Urinary Bladder - surgery
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2018.02.003

To characterize the causes of re-augmentation in patients with classic bladder exstrophy (CBE). A prospectively maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for patients with CBE who underwent more than 1 augmentation cystoplasty (AC) procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated. A total of 166 patients with CBE underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17 of 17), inadequate bladder necks (8 of 17), failed rattail augmentation (2 of 17), stomal incontinence (1 of 17), a urethrocutaneous fistula (1 of 17), and an hourglass augmentation (1 of 17). Of note, 5 of the 17 patients (29%) had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), whereas the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm (standard deviation [SD] 3.6) compared with 19 cm (SD 5.0) during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm (SD 4). The mean re-augmentation preoperative bladder capacity of 100 mL (SD 60) immediately increased after re-augmentation to 180.8 mL (SD 56.4) (P = .0001). Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure.