Bladder Re-augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention

Karl S. Benz, John Jayman, Karen Doersch, Mahir Maruf, Timothy Baumgartner, Matthew Kasprenski, John Phillip Gearhart

Research output: Contribution to journalArticle

Abstract

Objective: To characterize the causes of re-augmentation in patients with classic bladder exstrophy (CBE). Methods: A prospectively maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for patients with CBE who underwent more than 1 augmentation cystoplasty (AC) procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated. Results: A total of 166 patients with CBE underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17 of 17), inadequate bladder necks (8 of 17), failed rattail augmentation (2 of 17), stomal incontinence (1 of 17), a urethrocutaneous fistula (1 of 17), and an hourglass augmentation (1 of 17). Of note, 5 of the 17 patients (29%) had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), whereas the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm (standard deviation [SD] 3.6) compared with 19 cm (SD 5.0) during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm (SD 4). The mean re-augmentation preoperative bladder capacity of 100 mL (SD 60) immediately increased after re-augmentation to 180.8 mL (SD 56.4) (P =.0001). Conclusion: Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2018

ASJC Scopus subject areas

  • Urology

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    Benz, K. S., Jayman, J., Doersch, K., Maruf, M., Baumgartner, T., Kasprenski, M., & Gearhart, J. P. (Accepted/In press). Bladder Re-augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention. Urology. https://doi.org/10.1016/j.urology.2018.02.003