Editorial Comment to Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non-lethal complications of bladder augmentation.

Abstract

The review article by Husmann disclosed the complications and consequences of bladder augmentation with continent catheterizable stoma for more than one or two decades.1 In addition to improving their surgical skills, pediatric urologists who operate on children with hostile bladder should accept the advice of one of the most reliable transitional urologists. For children with spina bifida and bladder exstrophy, these complicated surgeries are not a goal, but the start for a new daily care routine of their bladder. After patients become independent of their parents, they might be non-compliant with the daily care routine of their augmented bladder, which includes clean intermittent catheterization, bladder irrigation and taking necessary medications. After several decades, the following complications would be inevitable: upper and lower urinary tract stones, metabolic abnormalities, and urinary tract infection. They are required to be more motivated to manage their health, with regular intermittent self-catheterization, daily high-volume bladder irrigation, and regular consultations with their doctor to check serum electrolytes, vitamin B12, creatinine and bone health. Although continent catheterizable stoma is helpful for these patients, Monti–Yang tubes and appendicovesicostomy have serious stomal complications because of their anatomical nature. Furthermore, developing obesity would exacerbate these complications, as most spina bifida patients become obese in adulthood. The author highlighted that the nutritional management of patients from childhood through to adulthood is essential to prevent future obesity. In addition, we would like to recommend reconsidering non-surgical treatments, such as bladder pressure-lowering medications, overnight catheterization and onabotulinumtoxin A, before embarking on bladder augmentation. We must never forget that patient selection is the most important factor to take into account before carrying out bladder augmentation with or without continent catheterizable stoma. None declared.