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Mark P Cain - One of the best experts on this subject based on the ideXlab platform.

  • additional surgeries after Bladder Augmentation in patients with spina bifida in the 21st century
    The Journal of Urology, 2020
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Martin Kaefer, Benjamin Whittam, Richard C Rink, Nathan Hollowell, Rachel E Hardacker, Carly R Swenson, Mark P Cain
    Abstract:

    Purpose:We determined the long-term risks of additional surgery after Bladder Augmentation in a modern spina bifida cohort accounting for differential followup.Materials and Methods:We retrospectiv...

  • Long-term follow-up of composite Bladder Augmentation incorporating stomach in a multi-institutional cohort of patients with cloacal exstrophy
    Journal of pediatric urology, 2016
    Co-Authors: Jessica T. Casey, Rosalia Misseri, Martin Kaefer, Richard C Rink, Katherine H. Chan, Y. Hasegawa, Tim Large, Benjamin Judge, K. Ueoka, Mark P Cain
    Abstract:

    Summary Introduction Composite Bladder Augmentation, incorporating gastric and bowel segments, has the theoretical advantage of metabolic neutrality while potentially avoiding the morbidities of gastrocystoplasty, such as hematuria-dysuria syndrome. The most common indication for this operation is a paucity of bowel, such as in cloacal exstrophy. Despite several early descriptive studies of this technique, there are no reports, to date, of long-term follow-up in this population. Objective To describe the outcomes of composite Bladder Augmentation utilizing stomach in a cohort of cloacal exstrophy patients. Materials and Methods A retrospective review of cloacal exstrophy patients who underwent composite Bladder Augmentation from 1984 to 2006 at two institutions was performed. The incidence of mortality and morbidities related to Augmentation was evaluated. Results Eleven patients with cloacal exstrophy underwent composite Bladder Augmentation. Median age at initial Augmentation was 6.4 years (interquartile range (IQR) 4.4–9.1). Median follow-up was 13.2 years (IQR 11.2–24.6). The Summary table describes the types of composite Bladder Augmentations. Of the three patients with pre-operative metabolic acidosis, two improved with composite Bladder Augmentation and one developed metabolic alkalosis. Three developed hematuria-dysuria syndrome: one improved with staged ileocystoplasty, and two had persistent symptoms successfully treated with H2 receptor blockers. Two of 11 developed symptomatic Bladder stones. There were no reported Bladder perforations, Bladder malignancies, conversions to incontinent urinary diversions, or deaths. Conclusion With long-term follow-up, very few patients developed metabolic acidosis/alkalosis after composite Bladder Augmentation. The composite Bladder Augmentation will continue to be used in patients with cloacal exstrophy, in order to minimize the impact on the pre-existing short gut in these patients. Summary table . Description of the types of composite Bladder Augmentations. Type of composite Bladder Augmentation Number of patients (%) Gastrocystoplasty onto hindgut incorporated during initial Bladder closure 2 (18.2%) Gastrocystoplasty with subsequent ileocystoplasty 2 (18.2%) Initial composite Bladder Augmentation with both stomach and ileum 5 (45.5%) Multiple Augmentations with a final composition of stomach and ileum 2 (18.2%)

  • Bladder stones after Bladder Augmentation are not what they seem.
    Journal of pediatric urology, 2015
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Martin Kaefer, Benjamin Whittam, Richard C Rink, James E. Lingeman, Sable Amstutz, Joshua D. Ring, Mark P Cain
    Abstract:

    Summary Introduction Bladder and renal calculi after Bladder Augmentation are thought to be primarily infectious, yet few studies have reported stone composition. Objective The primary aim was to assess Bladder stone composition after Augmentation, and renal stone composition in those with subsequent nephrolithiasis. The exploratory secondary aim was to screen for possible risk factors for developing infectious stones. Study design Patients treated for Bladder stones after Bladder Augmentation at the present institution between 1981 and 2012 were retrospectively reviewed. Data were collected on demographics, surgeries and stone composition. Patients without stone analysis were excluded. Stones containing struvite, carbonate apatite or ammonium acid ureate were classified as infectious. The following variables were analyzed for a possible association with infectious Bladder stone composition: gender, history of cloacal exstrophy, ambulatory status, nephrolithiasis, recurrent urea-splitting urinary tract infections, first vs recurrent stones, timing of presentation with a calculus, history of Bladder neck procedures, catheterizable channel and vesicoureteral reflux. Fisher's exact test was used for analysis. Results Of the 107 patients with Bladder stones after Bladder Augmentation, 85 met inclusion criteria. Median age at Augmentation was 8.0 years (follow-up 10.8 years). Forty-four patients (51.8%) recurred (14 multiple recurrences, 143 Bladder stones). Renal calculi developed in 19 (22.4%) patients with a Bladder stone, and 10 (52.6%) recurred (30 renal stones). Overall, 30.8% of Bladder stones were non-infectious (Table). Among patients recurring after an infectious Bladder stone, 30.4% recurred with a non-infectious one. Among patients recurring after a non-infectious stone, 84.6% recurred with a non-infectious one (P = 0.005). Compared with Bladder stones, renal stones were more likely to be non-infectious (60.0%, P = 0.003). Of patients with recurrent renal calculi after an infectious stone, 40.0% recurred with a non-infectious one. No clinical variables were significantly associated with infectious stone composition on univariate (≥0.28) or bivariate analysis (≥0.36). Discussion This study had several limitations: it was not possible to accurately assess adherence with Bladder irrigations, and routine metabolic evaluations were not performed. The findings may not apply to patients in all clinical settings. While stone analysis was available for 3/4 of the stones, similar rates of incomplete stone analyses have been reported in other series. Conclusions In patients with Bladder Augmentation, 1/3 of Bladder stones and >1/2 of renal stones were non-infectious. Furthermore, an infectious stone does not imply an infectious recurrent stone and no known clinical variables appear to be associated with stone composition, suggesting that there is a possible metabolic component in stone formation after Bladder Augmentation. Table . Stone composition of Bladder and renal stones in patients with augmented Bladders. Stone composition Bladder stones (n = 143) (%) Renal stones (n = 30) (%) Infectious stones 99 (69.2%) 12 (40.0%)  Struvite 79 (55.2%) 11 (36.7%)  Pure carbonate apatite 15 (10.5%) 1 (3.3%)  Pure ammonium acid ureate 2 (1.4%) 0 (0.0%)  Mixed stones with calcium phosphate 4 (2.8%) 0 (0.0%) Non-infectious stones 44 (30.8%) 18 (60.0%)  Calcium phosphate 41 (28.7%) 14 (46.7%)  Pure calcium oxalate 0 (0.0%) 4 (13.3%)  Uric acid 3 (2.1%) 0 (0.0%)

  • mortality after Bladder Augmentation in children with spina bifida
    The Journal of Urology, 2015
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Cyrus M Adams, Jordan Kirkegaard, Martin Kaefer, Benjamin Whittam, Shelly King, Richard C Rink, Mark P Cain
    Abstract:

    Purpose: Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder Augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with Bladder Augmentation.Materials and Methods: We retrospectively reviewed the records of patients with spina bifida who underwent Bladder Augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at Augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis.Results: Of 888 patients in our Bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A...

  • Long-Term Outcomes Following Bladder Augmentation in Children with Neurogenic Bladder
    Current Bladder Dysfunction Reports, 2014
    Co-Authors: A. Keenan, Rosalia Misseri, Benjamin Whittam, Mark P Cain
    Abstract:

    Bladder Augmentation remains the final step in the management of refractory neurogenic Bladder (NGB) for many children who have failed medical management. The long-term risks and benefits of Augmentation surgery are important to understand when counseling patients about management options and when following augmented patients postoperatively. Benefits of Bladder Augmentation include improved continence, decreased risk of upper tract deterioration, possibly improved quality of life, and even reduced risk of renal-related mortality. However, risks are not trivial and include the potential need for further surgery, calculi formation, Bladder perforation, acid-base disturbances, vitamin B12 deficiency, and possibly malignancy. Therefore, patients considered for Augmentation should be well counseled and selected and subsequently must be followed closely by an experienced urologist for the duration of their lives.

Bradley P. Kropp - One of the best experts on this subject based on the ideXlab platform.

  • Small-intestinal submucosa for Bladder Augmentation: a review of preclinical studies
    World journal of urology, 1998
    Co-Authors: Bradley P. Kropp
    Abstract:

    The need to find an alternative to the use of bowel for urinary reconstruction has renewed research interests involving Bladder regeneration. Historically, alloplastic and biodegradable materials have demonstrated Bladder regeneration; however, high complication rates and unreliable regenerative results have prevented any of these materials from being used clinically. Small-intestinal submucosa (SIS) is an acellular, nonimmunogenic, biodegradable, xenogeneic, collagen-based material that is derived from the submucosa layer of porcine small intestine. SIS has demonstrated regenerative capacities in multiple organ systems, including the aorta, vena cava, ligaments, tendons, abdominal wall, and skin. SIS has also demonstrated long-term reliable regenerative results in the rat and canine Bladder-Augmentation models. This article reviews the preclinical studies involving the use of SIS for Bladder Augmentation.

  • ARTIFICIAL URINARY SPHINCTER IN THE TREATMENT OF URINARY INCONTINENCE: PREOPERATIVE URODYNAMICS DO NOT PREDICT THE NEED FOR FUTURE Bladder Augmentation
    The Journal of urology, 1998
    Co-Authors: Kevin M. Kronner, Richard C Rink, Bradley P. Kropp, Garrick R. Simmons, Anthony J. Casale, Mark P Cain
    Abstract:

    AbstractPurpose: The artificial urinary sphincter has been used to treat urinary incontinence in pediatric patients with neurogenic Bladders secondary to myelodysplasia. Frequently Bladder Augmentation is performed in conjunction with the artificial urinary sphincter implantation. Identifying patients with adequate urinary reservoirs who are candidates for implantation without Bladder Augmentation is a clinical challenge. We reviewed our experience with the artificial urinary sphincter in children with myelodysplasia to determine whether preoperative urodynamic findings predict the need for future Augmentation cystoplasty.Materials and Methods: We identified 38 patients younger than 18 years at artificial urinary sphincter implantation who did not undergo Augmentation enterocystoplasty before or at implantation. We evaluated preoperative Bladder capacity and compliance to determine whether these standard preoperative urodynamic measurements predict the eventual need for Bladder Augmentation in these patie...

  • regenerative urinary Bladder Augmentation using small intestinal submucosa urodynamic and histopathologic assessment in long term canine Bladder Augmentations
    The Journal of Urology, 1996
    Co-Authors: Bradley P. Kropp, Richard C Rink, Marian K Rippy, Stephen F Badylak, Mark C Adams, Michael A Keating, Karl B Thor
    Abstract:

    AbstractPurpose: To evaluate small intestinal submucosa (SIS) as a possible Bladder Augmentation material.Materials and Methods: Nineteen male dogs underwent 35 to 45 percent partial cystectomy with immediate Augmentation with SIS grafts. All dogs were evaluated pre- and postoperatively with blood chemistries, urine cultures, intravenous urograms, cystograms and cystometrograms. Postoperatively (1 to 15 months), Bladders were examined with routine histology and image analysis.Results: All dogs survived their intended survival period without morbidity. All results were normal. Histologically, all 3 layers (mucosa, smooth muscle, serosa) of the normal Bladder showed evidence of regeneration.Conclusions: Small intestinal submucosa acts as a scaffold for Bladder Augmentation through regeneration and could be a potential option for Bladder reconstruction.

Giacomo Passerini Glazel - One of the best experts on this subject based on the ideXlab platform.

  • Kidney transplantation into Bladder Augmentation or urinary diversion: long-term results.
    Transplantation, 2005
    Co-Authors: Waifro Rigamonti, Alfio Capizzi, Graziella Zacchello, Vincenzo Capizzi, Giovanni Franco Zanon, Giovanni Montini, Luisa Murer, Giacomo Passerini Glazel
    Abstract:

    We report on a single-institutional experience with renal transplantation in patients with severe lower urinary tract dysfunction (LUTD) who underwent Bladder Augmentation or urinary diversion, and assess the long-term results. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone Bladder Augmentation or urinary diversion. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with Bladder Augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent urinary diversion were reported. In the first group, surgical complications after kidney transplantation included one urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Drainage of transplanted kidneys into an augmented Bladder or urinary diversion is an appropriate management strategy when the native Bladder is unsuitable. Kidney transplantation in patients with Bladder Augmentation or urinary diversion for LUTD let achieve similar results to those obtained in the general population with normal lower urinary tracts.

  • kidney transplantation into Bladder Augmentation or urinary diversion long term results
    Transplantation, 2005
    Co-Authors: Waifro Rigamonti, Alfio Capizzi, Graziella Zacchello, Vincenzo Capizzi, Giovanni Franco Zanon, Giovanni Montini, Luisa Murer, Giacomo Passerini Glazel
    Abstract:

    Background. We report on a single-institutional experience with renal transplantation in patients with severe lower urinary tract dysfunction (LUTD) who underwent Bladder Augmentation or urinary diversion, and assess the long-term results. Methods. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone Bladder Augmentation or urinary diversion. Results. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with Bladder Augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent urinary diversion were reported. In the first group, surgical complications after kidney transplantation included one urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Conclusions. Drainage of transplanted kidneys into an augmented Bladder or urinary diversion is an appropriate management strategy when the native Bladder is unsuitable. Kidney transplantation in patients with Bladder Augmentation or urinary diversion for LUTD let achieve similar results to those obtained in the general population with normal lower urinary tracts.

Richard C Rink - One of the best experts on this subject based on the ideXlab platform.

  • additional surgeries after Bladder Augmentation in patients with spina bifida in the 21st century
    The Journal of Urology, 2020
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Martin Kaefer, Benjamin Whittam, Richard C Rink, Nathan Hollowell, Rachel E Hardacker, Carly R Swenson, Mark P Cain
    Abstract:

    Purpose:We determined the long-term risks of additional surgery after Bladder Augmentation in a modern spina bifida cohort accounting for differential followup.Materials and Methods:We retrospectiv...

  • Long-term follow-up of composite Bladder Augmentation incorporating stomach in a multi-institutional cohort of patients with cloacal exstrophy
    Journal of pediatric urology, 2016
    Co-Authors: Jessica T. Casey, Rosalia Misseri, Martin Kaefer, Richard C Rink, Katherine H. Chan, Y. Hasegawa, Tim Large, Benjamin Judge, K. Ueoka, Mark P Cain
    Abstract:

    Summary Introduction Composite Bladder Augmentation, incorporating gastric and bowel segments, has the theoretical advantage of metabolic neutrality while potentially avoiding the morbidities of gastrocystoplasty, such as hematuria-dysuria syndrome. The most common indication for this operation is a paucity of bowel, such as in cloacal exstrophy. Despite several early descriptive studies of this technique, there are no reports, to date, of long-term follow-up in this population. Objective To describe the outcomes of composite Bladder Augmentation utilizing stomach in a cohort of cloacal exstrophy patients. Materials and Methods A retrospective review of cloacal exstrophy patients who underwent composite Bladder Augmentation from 1984 to 2006 at two institutions was performed. The incidence of mortality and morbidities related to Augmentation was evaluated. Results Eleven patients with cloacal exstrophy underwent composite Bladder Augmentation. Median age at initial Augmentation was 6.4 years (interquartile range (IQR) 4.4–9.1). Median follow-up was 13.2 years (IQR 11.2–24.6). The Summary table describes the types of composite Bladder Augmentations. Of the three patients with pre-operative metabolic acidosis, two improved with composite Bladder Augmentation and one developed metabolic alkalosis. Three developed hematuria-dysuria syndrome: one improved with staged ileocystoplasty, and two had persistent symptoms successfully treated with H2 receptor blockers. Two of 11 developed symptomatic Bladder stones. There were no reported Bladder perforations, Bladder malignancies, conversions to incontinent urinary diversions, or deaths. Conclusion With long-term follow-up, very few patients developed metabolic acidosis/alkalosis after composite Bladder Augmentation. The composite Bladder Augmentation will continue to be used in patients with cloacal exstrophy, in order to minimize the impact on the pre-existing short gut in these patients. Summary table . Description of the types of composite Bladder Augmentations. Type of composite Bladder Augmentation Number of patients (%) Gastrocystoplasty onto hindgut incorporated during initial Bladder closure 2 (18.2%) Gastrocystoplasty with subsequent ileocystoplasty 2 (18.2%) Initial composite Bladder Augmentation with both stomach and ileum 5 (45.5%) Multiple Augmentations with a final composition of stomach and ileum 2 (18.2%)

  • Bladder stones after Bladder Augmentation are not what they seem.
    Journal of pediatric urology, 2015
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Martin Kaefer, Benjamin Whittam, Richard C Rink, James E. Lingeman, Sable Amstutz, Joshua D. Ring, Mark P Cain
    Abstract:

    Summary Introduction Bladder and renal calculi after Bladder Augmentation are thought to be primarily infectious, yet few studies have reported stone composition. Objective The primary aim was to assess Bladder stone composition after Augmentation, and renal stone composition in those with subsequent nephrolithiasis. The exploratory secondary aim was to screen for possible risk factors for developing infectious stones. Study design Patients treated for Bladder stones after Bladder Augmentation at the present institution between 1981 and 2012 were retrospectively reviewed. Data were collected on demographics, surgeries and stone composition. Patients without stone analysis were excluded. Stones containing struvite, carbonate apatite or ammonium acid ureate were classified as infectious. The following variables were analyzed for a possible association with infectious Bladder stone composition: gender, history of cloacal exstrophy, ambulatory status, nephrolithiasis, recurrent urea-splitting urinary tract infections, first vs recurrent stones, timing of presentation with a calculus, history of Bladder neck procedures, catheterizable channel and vesicoureteral reflux. Fisher's exact test was used for analysis. Results Of the 107 patients with Bladder stones after Bladder Augmentation, 85 met inclusion criteria. Median age at Augmentation was 8.0 years (follow-up 10.8 years). Forty-four patients (51.8%) recurred (14 multiple recurrences, 143 Bladder stones). Renal calculi developed in 19 (22.4%) patients with a Bladder stone, and 10 (52.6%) recurred (30 renal stones). Overall, 30.8% of Bladder stones were non-infectious (Table). Among patients recurring after an infectious Bladder stone, 30.4% recurred with a non-infectious one. Among patients recurring after a non-infectious stone, 84.6% recurred with a non-infectious one (P = 0.005). Compared with Bladder stones, renal stones were more likely to be non-infectious (60.0%, P = 0.003). Of patients with recurrent renal calculi after an infectious stone, 40.0% recurred with a non-infectious one. No clinical variables were significantly associated with infectious stone composition on univariate (≥0.28) or bivariate analysis (≥0.36). Discussion This study had several limitations: it was not possible to accurately assess adherence with Bladder irrigations, and routine metabolic evaluations were not performed. The findings may not apply to patients in all clinical settings. While stone analysis was available for 3/4 of the stones, similar rates of incomplete stone analyses have been reported in other series. Conclusions In patients with Bladder Augmentation, 1/3 of Bladder stones and >1/2 of renal stones were non-infectious. Furthermore, an infectious stone does not imply an infectious recurrent stone and no known clinical variables appear to be associated with stone composition, suggesting that there is a possible metabolic component in stone formation after Bladder Augmentation. Table . Stone composition of Bladder and renal stones in patients with augmented Bladders. Stone composition Bladder stones (n = 143) (%) Renal stones (n = 30) (%) Infectious stones 99 (69.2%) 12 (40.0%)  Struvite 79 (55.2%) 11 (36.7%)  Pure carbonate apatite 15 (10.5%) 1 (3.3%)  Pure ammonium acid ureate 2 (1.4%) 0 (0.0%)  Mixed stones with calcium phosphate 4 (2.8%) 0 (0.0%) Non-infectious stones 44 (30.8%) 18 (60.0%)  Calcium phosphate 41 (28.7%) 14 (46.7%)  Pure calcium oxalate 0 (0.0%) 4 (13.3%)  Uric acid 3 (2.1%) 0 (0.0%)

  • mortality after Bladder Augmentation in children with spina bifida
    The Journal of Urology, 2015
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Cyrus M Adams, Jordan Kirkegaard, Martin Kaefer, Benjamin Whittam, Shelly King, Richard C Rink, Mark P Cain
    Abstract:

    Purpose: Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder Augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with Bladder Augmentation.Materials and Methods: We retrospectively reviewed the records of patients with spina bifida who underwent Bladder Augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at Augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis.Results: Of 888 patients in our Bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A...

  • Mortality after Bladder Augmentation in Children with Spina Bifida
    The Journal of urology, 2014
    Co-Authors: Konrad M Szymanski, Rosalia Misseri, Cyrus M Adams, Jordan Kirkegaard, Martin Kaefer, Benjamin Whittam, Shelly King, Richard C Rink, Mark P Cain
    Abstract:

    Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder Augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with Bladder Augmentation. We retrospectively reviewed the records of patients with spina bifida who underwent Bladder Augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at Augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis. Of 888 patients in our Bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A total of 28 deaths (7.6%) occurred. The leading causes of mortality were nonurological infections (ventriculoperitoneal shunt related, decubitus ulcer fasciitis, etc) and pulmonary disease. Two patients (0.5%) died of renal failure. No patient died of malignancy or Bladder perforation. Patients with a ventriculoperitoneal shunt had a higher mortality rate than those without a shunt (8.9% vs 1.5%, p = 0.04). Previously reported mortality rates of 50% to 60% in patients with spina bifida do not appear to apply in children who have undergone Bladder Augmentation. On long-term followup leading causes of death in patients with spina bifida after Bladder Augmentation were nonurological infections rather than complications associated with Augmentation or renal failure. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Charles D Scales - One of the best experts on this subject based on the ideXlab platform.

  • Bladder Augmentation versus urinary diversion in patients with spina bifida in the united states
    The Journal of Urology, 2011
    Co-Authors: John S Wiener, Jodi Antonelli, Alisa M Shea, Lesley H Curtis, Kevin A Schulman, Tracey L Krupski, Charles D Scales
    Abstract:

    Purpose: Augmentation cystoplasty has replaced urinary diversion as the cornerstone of surgical management of refractory neurogenic Bladder in patients with spina bifida. Other than single institution series little is known about practice patterns of Bladder Augmentation vs diversion. Therefore, we characterized the use of Bladder Augmentation and urinary diversion in patients with spina bifida in a nationally representative, all payer, all ages data set.Materials and Methods: Discharge estimates were derived from the Nationwide Inpatient Sample. All patients who underwent Bladder Augmentation or ileal conduit diversion between 1998 and 2005 with a diagnosis consistent with spina bifida were included in the study.Results: Bladder Augmentation was performed in an estimated 3,403 patients and ileal loop diversion in 772 with spina bifida between 1998 and 2005. Patients fell into 2 clinically distinct populations. Those patients undergoing Bladder Augmentation tended to be younger (mean age 16 vs 36 years, p...

  • Bladder Augmentation Versus Urinary Diversion in Patients With Spina Bifida in the United States
    The Journal of urology, 2011
    Co-Authors: John S Wiener, Jodi Antonelli, Alisa M Shea, Lesley H Curtis, Kevin A Schulman, Tracey L Krupski, Charles D Scales
    Abstract:

    Augmentation cystoplasty has replaced urinary diversion as the cornerstone of surgical management of refractory neurogenic Bladder in patients with spina bifida. Other than single institution series little is known about practice patterns of Bladder Augmentation vs diversion. Therefore, we characterized the use of Bladder Augmentation and urinary diversion in patients with spina bifida in a nationally representative, all payer, all ages data set. Discharge estimates were derived from the Nationwide Inpatient Sample. All patients who underwent Bladder Augmentation or ileal conduit diversion between 1998 and 2005 with a diagnosis consistent with spina bifida were included in the study. Bladder Augmentation was performed in an estimated 3,403 patients and ileal loop diversion in 772 with spina bifida between 1998 and 2005. Patients fell into 2 clinically distinct populations. Those patients undergoing Bladder Augmentation tended to be younger (mean age 16 vs 36 years, p <0.001) and male (52% of Bladder Augmentations vs 43% of urinary diversions, p = 0.02), and to have private insurance (46% vs 29%, p <0.001) compared to those undergoing urinary diversion. Furthermore, patients undergoing urinary diversion required more health care resources, with significantly longer hospital stays, higher total charges and more use of home health care after discharge home. Augmentation cystoplasty is widely used in the surgical management of neurogenic Bladder in patients with spina bifida, although ileal loop diversion is still performed in a substantial proportion with clinically distinct characteristics. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.