Çocuk Hasta Grubunda İleal Augmentasyon Ameliyatının Uzun Dönem Sonuçları

Abstract

Objective We sought to present the long term results of ileal augmentation cystoplasty in pediatric patients and clinical factors affecting incontinence, upper urinary tract deterioration(UUTD), and reoperation rates.

Method Data of pediatric patients who receieved an ileal augmentation cytoplasty in our clinic between 1991 and 2020 were analyzed retrospectively. Patients receieving renal replacement therapy and those who were operated prior to a renal transplantation were excluded. Demographic variables and clinical factors affecting incontince, UUTD and reoperation rates were analyzed. Included parameters were age, gender, etiology, reflux status, preoperative renal functions, anti-reflux surgery, bladder neck procedures, Mitrofanoff/Monti procedures. In addition, patients with longer follow-up periods(>5 years) were compared with shorter follow-up (<5 years) group.

Results Mean patient age at operation was 9.5 ± 4.95 years and median follow-up time was 65 months (3-289). Incontinence rate was 25.9%. In multi-variate analyses bladder extrophy-epispadias complex (BEEC) etiology was significant for incontinence (p=0.001, OR: 9.493 %95 CI 3.042 –29.623). UUTD rate was 25.2%. Multivariate analyses revealed anti-reflux surgery (p=0.051, OR: 2.287 %95 CI 0.997 – 5.249) and pre-operative chronic renal disease status (p=0.056, OR:3.107 %95 CI 0.973 –9.917) to be close to statistical significance. 45(34.3%) patients had a total of 91 reoperations. Multi-variate analyses revealed BEEC (p=0.013, OR 4.235 %95 CI 1.361 – 13.181) and simultaneous Mitrofanoff/Monti procedure (p=0.022, OR 3.353 %95 CI 1.187 – 9.468) to be significant for reoperation. Longer follow-up period did not yield any increase in risk of reoperation, incontince or UUTD (p=0.581, p=1.000 ve p=0.841, respectively).

Conclusion Ileal augmentation cytoplasty is an important treatment modality for pediatric patients with incontinence and low capacity, hypo-compliant, high storage pressure bladders. BEEC group is under risk of incontinence and reoperation. Simultaneus Mitrofanoff/Monti procedure also increases risk of reoperations. Longer follow-up periods do not seem to change risk of complications.