Format

Send to

Choose Destination
J Urol. 2019 Dec;202(6):1256-1262. doi: 10.1097/JU.0000000000000552. Epub 2019 Sep 17.

Probability of Bladder Augmentation, Diversion and Clean Intermittent Catheterization in Classic Bladder Exstrophy: A 36-Year, Multi-Institutional, Retrospective Cohort Study.

Author information

1
Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
2
Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio.
3
Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
4
Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
5
Division of Pediatric Urology, Mayo Clinic and Mayo Medical School, Rochester, Minnesota.

Abstract

PURPOSE:

We assessed the probability of bladder augmentation/diversion and clean intermittent catheterization in classic bladder exstrophy in a multi-institutional cohort.

MATERIALS AND METHODS:

We included children born from 1980 to 2016 with bladder exstrophy and treated across 5 centers (exclusion criteria less than 1 year followup after birth, isolated epispadias, bladder exstrophy variants etc). Outcomes were probability of bladder augmentation/diversion after bladder closure and proportion of patients performing clean intermittent catheterization at last followup. Survival analysis was used.

RESULTS:

Of 216 patients 63.4% were male (median followup 14.4 years). Overall 4 patients (1.9%) underwent primary diversion and 212 underwent primary closure (72.6% in first week of life). After primary closure 50.9% underwent augmentation, 4.7% diversion and 44.8% neither. By age 18 years 88.5% underwent a bladder neck procedure (synchronous augmentation 27.3%). On survival analysis the probability of bladder augmentation/diversion was 14.9% by age 5 years, 50.7% by 10 years and 70.1% by 18 years. Probability of bladder augmentation/diversion varied significantly between centers (p=0.01). Probability of bladder augmentation/diversion was 60.7% 10 years after bladder neck procedure. At last followup of the entire cohort 67.4% performed clean intermittent catheterization. Among 95 patients with intact native bladders 30.5% performed clean intermittent catheterization (channel 72.4%). Among 76 adults without a diversion 85.5% performed clean intermittent catheterization (augmented bladder 100.0% clean intermittent catheterization, native bladder 31.3%). Fifteen patients underwent diversion (continent 8, ureterosigmoidostomy 5, incontinent 2).

CONCLUSIONS:

On long-term followup probability of bladder augmentation/diversion increased with age, with 1 in 2 patients by age 10 years and the majority in adulthood. Probability of bladder augmentation/diversion differed among institutions. Almost a third of patients, including adults, with a closed native bladder performed clean intermittent catheterization. Considering all adults only 14% did not perform clean intermittent catheterization.

KEYWORDS:

bladder exstrophy; urinary catheterization; urinary diversion; urologic surgical procedures

PMID:
31526259
DOI:
10.1097/JU.0000000000000552
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center