Long-term surgical outcomes of ileovesicostomy at a single children's hospital.

IF 2 3区 医学 Q2 PEDIATRICS
Viktor X Flores, Brendan Frainey, Matthew Mikhael, Benjamin N Abelson, Belinda Li, Heidi Chen, Cyrus M Adams, Abby S Taylor, John C Thomas, John C Pope, Mark C Adams, John W Brock, Douglass B Clayton
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引用次数: 0

Abstract

Introduction: The ileovesicostomy (IV) is a surgical option for patients with refractory bladder dysfunction at-risk of upper tract deterioration who cannot catheterize or lack social support for managing an augmentation cystoplasty (AC). Long-term outcomes after IV in children are lacking in the literature.

Objective: We assessed the risk of long-term surgical complications in pediatric patients with IV at a single children's hospital.

Study design: We retrospectively reviewed the records of patients undergoing IV between 2002 and 2021 at a single children's hospital. The primary outcome was the rate of surgical complications in IV patients after initial reconstruction. Specific complications of interest included intra-abdominal, reservoir, and stomal complications, respectively. We also assessed renal outcomes, including the change in glomerular filtration rate (ΔGFR) and Society of Fetal Urology (ΔSFU) hydronephrosis from the time of surgery to last follow up.

Results: The study comprised 17 IV patients, with most patients having a diagnosis of spina bifida (65 %). Median follow-up was 6.4 years. The mean rate of surgical complications per patient year was 0.11 ± 0.20. On survival analysis, the time to first complication for IV was 84.4 months. The incidence of intra-abdominal, reservoir, and stomal complications over the study period was 2/17 (11.8 %) for each of these complication types. The mean ΔSFU grade from the time of surgery to last follow up was -1.24 ± 1.48 and mean ΔGFR was -2.5 ± 32.7 ml/min.

Discussion: We found that IV in pediatric patients experience a low rate (0.11/year) of complications and that median time to first complication was 84 months. Additionally, IV offers adequate renal preservation. Our study is limited, though, by its retrospective nature, small sample size, heterogenous population and lack of comparison group.

Conclusion: Our experience demonstrates that IV has a low rate of surgical complications and preserves renal function. We believe it is a reasonable surgical option for the well selected patient with refractory bladder dysfunction at-risk of upper tract deterioration who is unable to reliably catheterize.

一家儿童医院回肠造口术的长期手术效果。
简介:回肠造口术(IV)是一种手术选择,适用于不能导尿或缺乏社会支持以管理增强膀胱成形术(AC)的难治性膀胱功能障碍且面临上尿路恶化风险的患者。儿童膀胱造瘘术后的长期疗效尚缺乏文献报道:我们评估了在一家儿童医院接受静脉注射的儿童患者出现长期手术并发症的风险:研究设计:我们回顾性审查了一家儿童医院 2002 年至 2021 年期间接受静脉注射的患者的病历。主要结果是IV患者在初次重建后的手术并发症发生率。具体的并发症包括腹腔内并发症、贮水池并发症和口腔并发症。我们还评估了肾脏结果,包括从手术到最后一次随访期间肾小球滤过率(ΔGFR)和胎儿泌尿外科学会肾积水(ΔSFU)的变化:研究包括 17 例 IV 型患者,大多数患者被诊断为脊柱裂(65%)。中位随访时间为 6.4 年。每名患者每年的手术并发症平均发生率为 0.11 ± 0.20。根据生存分析,IV期患者首次出现并发症的时间为84.4个月。在研究期间,腹腔内并发症、储液器并发症和口腔并发症的发生率分别为2/17(11.8%)。从手术到最后一次随访的平均ΔSFU分级为-1.24 ± 1.48,平均ΔGFR为-2.5 ± 32.7 ml/min:我们发现,小儿患者静脉注射的并发症发生率较低(0.11/年),首次并发症发生的中位时间为84个月。此外,静脉注射还能充分保护肾脏。虽然我们的研究具有回顾性、样本量小、异质人群和缺乏对比组等局限性,但还是得出了结论:我们的经验表明,静脉注射的手术并发症发生率低,并能保留肾功能。我们认为,对于经过严格筛选、有上尿路恶化风险、无法可靠导尿的难治性膀胱功能障碍患者来说,这是一种合理的手术选择。
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来源期刊
Journal of Pediatric Urology
Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY
CiteScore
3.70
自引率
15.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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