Ileal Enterocystoplasty and B12 Deficiency in Pediatric Patients

Abstract

PURPOSE Vitamin B12 deficiency is a feared complication of enterocystoplasty, but it has never been demonstrated in pediatric patients who have undergone ileal enterocystoplasty. We reviewed our series of over 500 bladder augmentations in an attempt to define the timing and risk of vitamin B12 deficiency in pediatric patients after bladder augmentation. MATERIAL AND METHODS From October 2004 to present, we obtained serum B12 values on patients who had undergone bladder augmentation at our institution. We looked at patients who had an ileal enterocystoplasty and who were 18 years or younger at the time of augmentation. Any B12 value that was obtained while on any form of B12 supplementation was excluded. These criteria resulted in 79 patients with 105 B12 values. B12 values less than 200 pg/mL were considered “low” and values between 201–300 pg/mL were considered “low-normal.” RESULTS There was a statistically significant correlation between follow-up time and serum B12 (p = 0.0001). The probability of “low” B12 increased as follow-up time increased (p = 0.007), as well as the probability of “low-normal” B12 with longer follow-up time (p = 0.005). Starting at 7 years post-operatively, 6 of 29 patients (21%) had low B12 values, while 12 of 29 patients (41%) had low-normal values. CONCLUSIONS Pediatric patients who have undergone ileal enterocystoplasty are at risk for developing vitamin B12 deficiency. These patients are at the highest risk beginning at 7 years post-operatively, and their risk increases with time. We recommend an annual serum B12 value beginning at 5 years following bladder augmentation in children.