Journal of pediatric urology · 2026
Long-term outcomes and risk factors for reoperation after ileal augmentation in children: A single-center study.
СтатьяНазвание и аннотация: Перевод в очереди
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Asci Ahmet, Altan Mesut, Ayva Mujdat, Dogan Hasan Serkan, Tekgul Serdar
Аннотация
INTRODUCTION: Patients with certain lower urinary tract anomalies may develop high-pressure, low-capacity bladders, risking incontinence and upper urinary tract damage. If conservative treatments fail, augmentation surgery aims to improve bladder capacity, maintain continence, and protect the upper urinary tract. Long-term follow-up is vital, as over half of patients may require reoperations, making identification of risk factors and optimal management important.
AIM: To evaluate factors influencing the risk of reoperation, upper urinary tract deterioration (UUTD), and incontinence in children undergoing ileal augmentation (IA).
PATIENTS AND METHODS: A retrospective analysis was conducted on 131 patients who underwent IA surgery between July 1991 and January 2023 at a single center. Data included demographics, etiology, vesicoureteral reflux (VUR), preoperative renal function, anti-reflux surgery, bladder neck procedures, and catheterizable stoma procedures (CSP; Mitrofanoff/Monti). Factors affecting postoperative incontinence, UUTD, and reoperation rates were analyzed.
RESULTS: The mean age at operation was 9.5 ± 4.95 years, with 55 males and 76 females. Over a median follow-up of 65 months, new-onset UUTD was observed in 33 patients (25.2 %). Anti-reflux surgery (p = 0.033) and preoperative chronic renal disease (CRD) (p = 0.045) were significant in univariate analysis. A total of 91 reoperations were performed on 45 patients (34.3 %). Multivariate analysis identified bladder exstrophy-epispadias complex (BEEC, p = 0.013) and CSP (p = 0.022) as significant risk factors for reoperation. Postoperative incontinence occurred in 34 patients (25.9 %), with BEEC being significant in multivariate analyses (p < 0.001). Patients with follow-up exceeding 10 years had higher reoperation risk (48.3 % vs. 30.4 %, p = 0.081), though not statistically significant. Incontinence (27.6 % vs. 23.5 %, p = 0.633) and UUTD (27.6 % vs. 24.5 %, p = 0.809) rates were similar.
DISCUSSION: BEEC is associated with higher postoperative incontinence and reoperation risks. CSP was associated with higher reoperation risks. Longer follow-up periods did not seem to affect incontinence and UUTD rates, but reoperation rates seem to be higher.
CONCLUSION: IA is a complex surgery requiring long-term follow-up. Certain patient groups are under higher risk for incontinence and reoperation. Longer follow-up periods may lead to higher reoperation rates.
CLINICAL APPLICABILITY: Given the pediatric nature of this patient group and their long life expectancy, better knowledge of the long-term outcomes, complications, and the need for reoperations will aid in management of these complications and provide useful information for families towards the prognosis of this surgery.
AIM: To evaluate factors influencing the risk of reoperation, upper urinary tract deterioration (UUTD), and incontinence in children undergoing ileal augmentation (IA).
PATIENTS AND METHODS: A retrospective analysis was conducted on 131 patients who underwent IA surgery between July 1991 and January 2023 at a single center. Data included demographics, etiology, vesicoureteral reflux (VUR), preoperative renal function, anti-reflux surgery, bladder neck procedures, and catheterizable stoma procedures (CSP; Mitrofanoff/Monti). Factors affecting postoperative incontinence, UUTD, and reoperation rates were analyzed.
RESULTS: The mean age at operation was 9.5 ± 4.95 years, with 55 males and 76 females. Over a median follow-up of 65 months, new-onset UUTD was observed in 33 patients (25.2 %). Anti-reflux surgery (p = 0.033) and preoperative chronic renal disease (CRD) (p = 0.045) were significant in univariate analysis. A total of 91 reoperations were performed on 45 patients (34.3 %). Multivariate analysis identified bladder exstrophy-epispadias complex (BEEC, p = 0.013) and CSP (p = 0.022) as significant risk factors for reoperation. Postoperative incontinence occurred in 34 patients (25.9 %), with BEEC being significant in multivariate analyses (p < 0.001). Patients with follow-up exceeding 10 years had higher reoperation risk (48.3 % vs. 30.4 %, p = 0.081), though not statistically significant. Incontinence (27.6 % vs. 23.5 %, p = 0.633) and UUTD (27.6 % vs. 24.5 %, p = 0.809) rates were similar.
DISCUSSION: BEEC is associated with higher postoperative incontinence and reoperation risks. CSP was associated with higher reoperation risks. Longer follow-up periods did not seem to affect incontinence and UUTD rates, but reoperation rates seem to be higher.
CONCLUSION: IA is a complex surgery requiring long-term follow-up. Certain patient groups are under higher risk for incontinence and reoperation. Longer follow-up periods may lead to higher reoperation rates.
CLINICAL APPLICABILITY: Given the pediatric nature of this patient group and their long life expectancy, better knowledge of the long-term outcomes, complications, and the need for reoperations will aid in management of these complications and provide useful information for families towards the prognosis of this surgery.