Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

S23-6

(P)

LONG-TERM FOLLOW-UP OF COMPOSITE BLADDER AUGMENTATION

INCORPORATING SOMTACH IN A MULTI-INSTITUTIONAL COHORT OF PATIENTS

WITH CLOACAL EXSTROPHY

Jessica CASEY

, Katherine HUBERT

, Yuichi HASEGAWA

, Timothy LARGE

, Benjamin JUDGE

, Martin KAEFER

, Rosalia

MISSERI

, Richard RINK

, Katsuhiko UEOKA

and Mark CAIN

1) Riley Hospital for Children, Division of Pediatric Urology, Indianapolis, USA - 2) National Center for Child Health and

Development, Division of Urology, Department of Surgical Subspecialties, Tokyo, JAPAN

PURPOSE

Composite bladder augmentation (CBA), incorporating gastric and bowel segments, has the theoretical advantage of

metabolic neutrality while potentially avoiding the morbidities of gastrocystoplasty, such as hematuria dysuria syndrome

(HDS). The most common indication for this operation is a paucity of bowel, such as in cloacal exstrophy (CE). Despite

several early descriptive studies of this technique, there arenoreports of long-term follow-up in this population.

MATERIAL AND METHODS

We performed a retrospective review of CE patients ≤ 21 years old who underwent CBA from 1984-2006 at two

institutions. We evaluated the incidence of mortality and morbidities related to augmentation.

RESULTS

11 patients with CE underwent CBA. Median age at initial augmentation was 6.4 years (interquartile range (IQR) 4.4-

9.1). Median follow-up was 11.9 years (IQR 8.3-24.1). Two patients underwent gastrocystoplasty onto hindgut

incorporated during initial bladder closure, two underwent gastrocystoplasty with subsequent ileocystoplasty, five

underwent initial CBA with both stomach and ileum, and two underwent multiple augmentations with a final composition

of stomach and ileum. Of the three patients (27.3%) with preoperative metabolic acidosis, two improved with CBA and

one developed metabolic alkalosis. Three (27.3%) developed HDS; one improved with staged ileocystoplasty, and two

were successfully treated with H2 blockers. Two (18.2%) developed symptomatic bladder stones. There were no

reported bladder perforations, bladder malignancies, urinary diversions or deaths.

CONCLUSIONS

With long-term follow-up, very few patients developed metabolic acidosis/alkalosis after CBA. We continue to use the

CBA in patients with CE in order to minimize the impact on the pre-existing short gut in these patients.