Mortality after bladder augmentation in children with spina bifida

Konrad M. Szymanski, Rosalia Misseri, Benjamin Whittam, Cyrus M. Adams, Jordan Kirkegaard, Shelly King, Martin Kaefer, Richard C. Rink, Mark P. Cain

Research output: Contribution to journalArticle

23 Citations (Scopus)

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 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). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)643-649
Number of pages7
JournalJournal of Urology
Volume193
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Spinal Dysraphism
Urinary Bladder
Mortality
Renal Insufficiency
Ventriculoperitoneal Shunt
Cause of Death
Nonparametric Statistics
Fasciitis
Death Certificates
Social Security
Pressure Ulcer
Infection
Lung Diseases
Medical Records
Demography
Databases
Morbidity
Kidney
Survival

Keywords

  • mortality
  • spinal dysraphism
  • urinary bladder
  • urinary diversion
  • ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Urology

Cite this

Mortality after bladder augmentation in children with spina bifida. / Szymanski, Konrad M.; Misseri, Rosalia; Whittam, Benjamin; Adams, Cyrus M.; Kirkegaard, Jordan; King, Shelly; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.

In: Journal of Urology, Vol. 193, No. 2, 01.02.2015, p. 643-649.

Research output: Contribution to journalArticle

Szymanski, KM, Misseri, R, Whittam, B, Adams, CM, Kirkegaard, J, King, S, Kaefer, M, Rink, RC & Cain, MP 2015, 'Mortality after bladder augmentation in children with spina bifida', Journal of Urology, vol. 193, no. 2, pp. 643-649. https://doi.org/10.1016/j.juro.2014.07.101
Szymanski, Konrad M. ; Misseri, Rosalia ; Whittam, Benjamin ; Adams, Cyrus M. ; Kirkegaard, Jordan ; King, Shelly ; Kaefer, Martin ; Rink, Richard C. ; Cain, Mark P. / Mortality after bladder augmentation in children with spina bifida. In: Journal of Urology. 2015 ; Vol. 193, No. 2. pp. 643-649.
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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 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). Conclusions 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.",
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AU - Whittam, Benjamin

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AU - Kirkegaard, Jordan

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AU - Rink, Richard C.

AU - Cain, Mark P.

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N2 - 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 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). Conclusions 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.

AB - 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 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). Conclusions 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.

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KW - urinary diversion

KW - ventriculoperitoneal shunt

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