Augmentation cystoplasty and continent catheterizable channels in the bladder exstrophy-epispadias complex: A 20-year experience.

Abstract

Introduction: The variable presentation of the exstrophy-epispadias complex (EEC) has led to a variety of surgical and medical care practices for management of the condition. Augmentation cystoplasty (AC) is a procedure that can be used to increase the volume and compliance of the bladder to facilitate a functional storage vessel for urine that does not put the upper urinary tract under high pressure.

Objective: To determine risk factors for complications after augmentation cystoplasty (AC) with continent catheterizable channel (CCC) in the EEC.

Study design: An IRB approved institutional database of EEC patients was reviewed retrospectively. Patients that had primary augmentation performed at our institution between 2003 and 2023 were included. Gender, race, primary closure outcome, bowel segment choice for augmentation and stoma, preoperative bladder capacity, bladder neck status, age at augmentation, 30- and 90-day complications, number of stomal revisions, and length of longer term follow-ups were reviewed. Comparisons were made among different risk factors and complications across AC type and CCC type.

Results: 186 patients underwent primary AC with CCC at our institution and 157 met final inclusion criteria (Table 1). The patients included 148 (94.3 %) classic bladder exstrophy, 6 (3.8 %) male epispadias and 3 (1.9 %) female epispadias. The mean age at time of AC was 11.3 years with a median follow up of 6.46 years. There was no significant difference in the length of bowel harvested by the ileum and colon groups (p = 0.0836) or closure outcome (p = 0.3013). There was increased usage of Monti stoma in patients with an ileum AC (p = 0.0034). Stomal revisions were also significantly more common in the ileum group (p = 0.0392). Closure outcome did not influence the rate of 30- and 90-day complications (p = 0.6560, p = 0.6761) or stoma choice (p = 0.7384). There was no significant difference between the ileum and colon augment groups in terms of 30- and 90-day complications (p = 0.8329, p = 0.2923, respectively). Multivariate Cox regression showed no significant association between stoma or augmentation type and time to postoperative complication (p = 0.94 and p = 0.77, respectively). Patients with a history of primary successful closure had a shorter hospital stay (p = 0.0042) but there was no difference in hospital stay between the ileum and colon groups (p = 0.6632).

Discussion: Bowel segment choice for AC does not influence the risk for complications in the EEC population. History of a failed primary closure leads to a longer hospital stay after AC, but there is no increased risk for complications.

Conclusion: Risks factors in the EEC population for complications after AC with CCC remain unknown.