Nonsecretory intestinocystoplasty: postoperative outcomes of 25 years

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0595


ORIGINAL ARTICLE

Rose A. F. Dantas 1, Fernanda C. F. S. Calisto 1, Fabio O. Vilar 2, Luiz A. P. Araujo 3, Salvador V. C. Lima 4
1 Programa de Pós-Graduação em Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil; 2 Departamento de Urologia, Hospital das Clínicas da Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil; 3 Departamento de Cirurgia Pediátrica, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil; 4 Departamento de Cirurgia, Centro de Ciências da Saúde da Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil

ABSTRACT

Objective: The objective of bladder augmentation (BA) is to create a low-pressure reservoir with adequate capacity. Despite its benefi ts, the use of intestinal patches in bladder enlargement provides a high risk of developing complications and BA with demucosalised bowel represents a potential alternative. Therefore, this study evaluated urological parameters and long-term clinical follow-up of patients submitted to nonsecretory BA in a single center with 25 years of experience.

Materials and Methods: Patients treated with BA underwent urological evaluation, which included history, physical examination and urodynamic study. The main urodynamic parameters (bladder capacity and bladder compliance) were assessed in the pre and postoperative moments, and compared by the Wilcoxon Signed Rank test. The main long-term complications were described.

Results: 269 patients (mean age 14±13 years, 47% male) underwent BA with the use of demucolised intestinal segments. Among the patients in the sample, 187 (69.52%) had neurogenic bladder, 68 (25.28%) had bladder exstrophy, nine had tuberculosis (3.34%), four had a posterior urethral valve (1.49%) and one with hypospadia (0.37%). After the surgical procedure, a signifi cant increment in both urodynamic parameters was found, with a 222% increase in bladder capacity and 604% in bladder compliance (p <0.001 in both analyzes). Mean follow-up time ranged from 2 to 358 months, with a median of 72 months (IQR 74-247). Among all patients, 5 presented spontaneous perforation.

Conclusion: The study showed statistically signifi cant increase in both compliance and bladder capacity after non-secretory BA, with a low rate of severe complications.

Keywords: Hypopituitarism; Urinary Bladder; Disease

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