Long-term renal functional outcomes after primary gastrocystoplasty

Katherine C. Hubert, Timothy Large, Jeffrey Leiser, Benjamin Judge, Konrad Szymanski, Benjamin Whittam, Martin Kaefer, Rosalia Misseri, Richard Rink, Mark P. Cain

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Purpose We assessed long-term renal function, morbidities and mortality in 50 patients who had undergone primary gastrocystoplasty at our institution. Materials and Methods We retrospectively reviewed patients 21 years or younger who had undergone primary gastrocystoplasty between 1984 and 2004. Patients who underwent secondary gastrocystoplasty or primary composite augmentation or had cloacal exstrophy were excluded. Primary outcome was progression to end-stage renal disease. Secondary outcomes included mortality, bladder malignancy, hematuria-dysuria syndrome, electrolyte abnormalities and surgical revisions. Results Of 50 patients who had undergone gastrocystoplasty 35 met inclusion criteria. Median age was 9.4 years and 60% of the patients were male. Median followup was 19 years (IQR 11 to 25). Of the 35 patients 15 (43%) had normal preoperative estimated glomerular filtration rate and 5 (14%) had stage 2, 10 (29%) stage 3 and 5 (14%) stage 4 chronic kidney disease. Five of the 15 patients with stage 3 or 4 chronic kidney disease improved to normal estimated glomerular filtration rate, 1 remained with stage 3 disease and 9 progressed to end-stage renal disease. In 1 patient with normal estimated glomerular filtration rate end-stage renal disease developed following an episode of septic shock due to osteomyelitis. Seven patients in the cohort (20%) died, with 1 each dying of ventriculoperitoneal shunt infection, pneumonia, end-stage renal disease, complications of pregnancy and unknown cause, and 2 patients dying of septic shock due to urinary tract infection. There were no bladder malignancies. Hematuria-dysuria syndrome developed in 9 patients (24%). Eight patients (23%) underwent surgical revision. Conclusions The majority of patients had preserved or improved renal function after gastrocystoplasty. There were no deaths attributable to gastric augmentation and no bladder malignancies. Approximately a fourth of patients required surgical revision.

Original languageEnglish (US)
Pages (from-to)2079-2085
Number of pages7
JournalJournal of Urology
Volume193
Issue number6
DOIs
StatePublished - Jun 1 2015

Keywords

  • follow-up studies
  • pediatrics
  • renal insufficiency
  • urologic surgical procedures

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

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    Hubert, K. C., Large, T., Leiser, J., Judge, B., Szymanski, K., Whittam, B., Kaefer, M., Misseri, R., Rink, R., & Cain, M. P. (2015). Long-term renal functional outcomes after primary gastrocystoplasty. Journal of Urology, 193(6), 2079-2085. https://doi.org/10.1016/j.juro.2014.12.088