Background:Enlargement cystoplasty is the treatment chosen for patients with neurogenic bladder resistant to medical treatment. Despite being the “gold standard” for resistant pharmacotherapy, reconstruction with intestine is associated with multiple complications. The primary objective is to evaluate the incidence of complications in patients with cystoplasty. The secondary objective is to identify risk factors for the development of these complications.
Material and methods: A retrospective cohort study that included patients with drug-resistant bladder dysfunctions underwent cystoplasty between 2003 to 2017, without bowel preparation in a single center. Patients with irregular follow-up were excluded. Variables included video urodynamics, renovesical ultrasound and renal function laboratory. Irregular bladder washings were defined: not daily, without increasing volumes; Recurrent UTIs: 4 per year and constipation by Rome IV criteria. CIC was performed in all patients. For quantitative variables, measures of centralization and dispersion were calculated and for categorical variables, absolute and percentage distributions were calculated. Student's t test was applied for the comparison of means and chi2 test for the correlation of categorical variables. In addition, survival analysis was used. InfoStat was used for statistical processing.
Results: 128 children were studied, (54%) were boys and the average age was 11 years (r: 4-18). The average follow-up time was 52 months. The most frequent etiologies were: spinal dysraphisms and anorectal malformation (69% and 15%, respectively). All were refractory to first and second line medical treatment: anticholinergics, β-agonists and botulinum neurotoxin A. The most frequent concurrent procedures to cystoplasty were: continent conduits for CIC, interventions in the bladder neck and ureterovesical reimplantations (59, 24 and 15% respectively). Sigmoid colon was the most used in reconstruction (78%), followed by ileum (22%). The most frequent mediate complications were: urinary fistula (5.5% associated with ileum) and acute occlusive abdomen (4%) within the 1st month, stenosis of the catheterizable stoma in the 1st year (8.6%), UTI in the 1st year (23%) and lithiasis in the 5th year (20%). The average onset of bladder stones was 51 months (8 to 144). 3 patients presented recurrence at an average of 78 months. Bladder lithiasis was associated with symptomatic UTI during the 1st year (p=0.0190), with irregular bladder washings in the third year (p=0.0017), as well as in the 5th year (p=0.0242). In the univariate analysis, lithiasis was related to children in wheelchairs and constipation. In the cumulative incidence analysis, the marginal probability of stones at 10, 30, 50 and 70 months was 2%, 8%, 12% and 20% respectively. Endoscopic treatment of stones was used in 54% and cystolithotomy in 46%. There were no significant differences in the majority of complications between the intestinal segments used.
Conclusions: Enlargement cystoplasty with intestine continues to take place in the face of pharmacological refractoriness to protect the upper urinary tract, although complications such as UTI and bladder stones developed, especially in those with irregular bladder washings, which require stricter follow-up with adequate adherence.
