Complications of Pediatric Bladder Reconstruction in the Adult Patient

Abstract

Bladder augmentation and associated reconstructive procedures are a surgical option for patients with urologic congenital anomalies and neuropathic bladder with the goal of improving continence and reducing the risk of upper tract deterioration. Despite these benefits, augmentation also portends several short- and long-term potential complications. The goal of this chapter is to discuss these complications and review the current literature on this topic. Metabolic abnormalities, including acid-base disorders and their sequelae, occur in 5–15% of patients with bladder augmentation and are typically seen within 5–10 years from intervention. Chronic bacteriuria and recurrent urinary tract infections often play a role in renal dysfunction and contribute to 70% of urinary tract stone disease. Bladder perforation is reported at rates between 3 and 13%, with associated mortality rates ranging from 1% to as high as 25%. Other more common surgical complications include catheterizable channel issues: stricture, false passage, stenosis, stomal prolapse, channel redundancy, and channel incontinence. Channel complications should be thought of as suprafascial vs. subfascial in order to help guide treatment options. Following augmentation cystoplasty, incidence of bladder cancer ranges from 0 to 5.5%; unfortunately, the vast majority present with locally advanced or node-positive disease. Therefore, yearly screening with cytology and cystoscopy is not recommended and symptom-based screening protocols have been proposed. Given the complexity and wide variety of complications possible after bladder augmentation, it is critical that these patients are closely followed into adulthood by a urologist, but also receive tailored multi-disciplinary care based on their specific medical and surgical needs.