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Growing up with a bladder augmentation
S58
ESPU Meeting 2007
# S10-6 (O)
LONG-TERM FOLLOW UP OF ENTERIC AUGMENTATIONS; THE RISK FOR MALIGNANCY Douglas HUSMANN and Susan RATHBUN Mayo Clinic, Urology, Rochester, USA
PURPOSE
RESULTS
To define the risk of malignant tumours developing in enteric bladder augmentation during long-term follow up.
153 patients met the study criteria; indications for bladder augmentation were neurogenic bladder in 97, exstrophyepispadias in 38 and posterior urethral valves in 18. Median follow-up interval of 27 years range 10e53 years. A total of 7 cases of malignancy occurred. Two patients with a neurogenic bladder developed multifocal transitional cell carcinoma; both were heavy smokers (> 50 pack year history). Two patients with a history of posterior urethral valves that subsequently required renal transplantation developed invasive adenocarcinoma of the enteric augment portion of the bladder. Three patients with bladder exstrophy developed multifocal adenocarcinoma of the bladder and enteric segment. Median time to
MATERIAL AND METHODS We reviewed all patients who had undergone an enteric bladder augmentation. To be included in the study, a minimum of 10 years of follow-up with a history of annual or biennial urologic follow-up evaluations were required. The patients were specifically reviewed for the development of a bladder malignancy.
development of the tumour was 32 years range 22 e 52 years. Radical cystectomy was performed in 6/7(85%) of the patients. (One patient with wide spread metastasis at diagnosis.) Three patients remain alive, median length of time from surgery 5 yrs., range 2e6 yrs. Four patients died from their malignancy.
CONCLUSIONS Malignancy following enteric augmentation frequently arose due to coexisting biologic stimuli; tobacco usage, immunosuppression or the possible inherent risk of malignancy from the native exstrophic bladder. Median lag time to tumour development was 3 decades.
# S10-7 (O)
GROWING UP WITH A BLADDER AUGMENTATION ´ A. MORENO VALLE*, Jose M. ALONSO DORREGO*, Pedro LOPEZ PEREIRA, Jose Maria Jose MARTINEZ-URRUTIAy, Laura BURGOSy, Roberto LOBATOy, Laura ESPINOSA and Enrique JAUREGUIZAR MONEREOy UNIVERSITY HOSPITAL LA PAZ, Pediatric Nephrology, Madrid, SPAIN - * UNIVERSITY HOSPITAL LA PAZ, Urology, Madrid, SPAIN - y UNIVERSITY HOSPITAL LA PAZ, Pediatric Urology, Madrd, SPAIN
PURPOSE This study assesses the clinical outcome of bladder augmentation performed before puberty in children with neuropathic bladders and a follow-up of at least 8 years.
hydronephrosis alone in 3 and UTI in 11. Seventeen patients (81%) had DMSA scars (unilateral in 11 and bilateral in 6). All patients underwent serum studies, renal ultrasound, VCUG, DMSA scan, urodynamic evaluation and cystoscopy screening for premalignant lesions.
Urodynamic studies showed good compliance in all neobladders (mean capacity 498.5 ml at a detrusor pressure < 10 cm H2O) and 7 (33%) had contractions during filling (28 cmH20/ 356 ml). All patients are dry day and night, and 2 do not need CIC. Cystoscopy was normal in all patients.
MATERIAL AND METHODS RESULTS A total of 21 patients with neuropathic bladders underwent bladder augmentation (3 ureterocystoplasties, 18 enterocystoplasties) before puberty at a mean age of 8.3 yrs (2.5-12). Indication for bladder augmentation were poor bladder compliance despite anticholinergic therapy and CIC, associated with VUR in 15 patients (3 had contralateral hydronephrosis),
Mean follow up was 11 yrs (8e14.5) and mean age at the end of follow-up was 19 yrs (13.2e26.8). Upper urinary tract dilatation disappeared in all patients and VUR in 13/15 (87%). No new scarring occurred. Only 1 patients had a febrile UTI due to poor CIC compliance and another had a bladder stone. GFR was normal at the end of follow-up in 20/21 patients.
CONCLUSIONS Bladder augmentation performed before puberty improves upper urinary tract dilatation, corrects VUR and preserves renal function until adulthood. Close follow-up improves the results and prevents complications
ESPU Meeting 2007
# S10-6 (O)
LONG-TERM FOLLOW UP OF ENTERIC AUGMENTATIONS; THE RISK FOR MALIGNANCY Douglas HUSMANN and Susan RATHBUN Mayo Clinic, Urology, Rochester, USA
PURPOSE
RESULTS
To define the risk of malignant tumours developing in enteric bladder augmentation during long-term follow up.
153 patients met the study criteria; indications for bladder augmentation were neurogenic bladder in 97, exstrophyepispadias in 38 and posterior urethral valves in 18. Median follow-up interval of 27 years range 10e53 years. A total of 7 cases of malignancy occurred. Two patients with a neurogenic bladder developed multifocal transitional cell carcinoma; both were heavy smokers (> 50 pack year history). Two patients with a history of posterior urethral valves that subsequently required renal transplantation developed invasive adenocarcinoma of the enteric augment portion of the bladder. Three patients with bladder exstrophy developed multifocal adenocarcinoma of the bladder and enteric segment. Median time to
MATERIAL AND METHODS We reviewed all patients who had undergone an enteric bladder augmentation. To be included in the study, a minimum of 10 years of follow-up with a history of annual or biennial urologic follow-up evaluations were required. The patients were specifically reviewed for the development of a bladder malignancy.
development of the tumour was 32 years range 22 e 52 years. Radical cystectomy was performed in 6/7(85%) of the patients. (One patient with wide spread metastasis at diagnosis.) Three patients remain alive, median length of time from surgery 5 yrs., range 2e6 yrs. Four patients died from their malignancy.
CONCLUSIONS Malignancy following enteric augmentation frequently arose due to coexisting biologic stimuli; tobacco usage, immunosuppression or the possible inherent risk of malignancy from the native exstrophic bladder. Median lag time to tumour development was 3 decades.
# S10-7 (O)
GROWING UP WITH A BLADDER AUGMENTATION ´ A. MORENO VALLE*, Jose M. ALONSO DORREGO*, Pedro LOPEZ PEREIRA, Jose Maria Jose MARTINEZ-URRUTIAy, Laura BURGOSy, Roberto LOBATOy, Laura ESPINOSA and Enrique JAUREGUIZAR MONEREOy UNIVERSITY HOSPITAL LA PAZ, Pediatric Nephrology, Madrid, SPAIN - * UNIVERSITY HOSPITAL LA PAZ, Urology, Madrid, SPAIN - y UNIVERSITY HOSPITAL LA PAZ, Pediatric Urology, Madrd, SPAIN
PURPOSE This study assesses the clinical outcome of bladder augmentation performed before puberty in children with neuropathic bladders and a follow-up of at least 8 years.
hydronephrosis alone in 3 and UTI in 11. Seventeen patients (81%) had DMSA scars (unilateral in 11 and bilateral in 6). All patients underwent serum studies, renal ultrasound, VCUG, DMSA scan, urodynamic evaluation and cystoscopy screening for premalignant lesions.
Urodynamic studies showed good compliance in all neobladders (mean capacity 498.5 ml at a detrusor pressure < 10 cm H2O) and 7 (33%) had contractions during filling (28 cmH20/ 356 ml). All patients are dry day and night, and 2 do not need CIC. Cystoscopy was normal in all patients.
MATERIAL AND METHODS RESULTS A total of 21 patients with neuropathic bladders underwent bladder augmentation (3 ureterocystoplasties, 18 enterocystoplasties) before puberty at a mean age of 8.3 yrs (2.5-12). Indication for bladder augmentation were poor bladder compliance despite anticholinergic therapy and CIC, associated with VUR in 15 patients (3 had contralateral hydronephrosis),
Mean follow up was 11 yrs (8e14.5) and mean age at the end of follow-up was 19 yrs (13.2e26.8). Upper urinary tract dilatation disappeared in all patients and VUR in 13/15 (87%). No new scarring occurred. Only 1 patients had a febrile UTI due to poor CIC compliance and another had a bladder stone. GFR was normal at the end of follow-up in 20/21 patients.
CONCLUSIONS Bladder augmentation performed before puberty improves upper urinary tract dilatation, corrects VUR and preserves renal function until adulthood. Close follow-up improves the results and prevents complications