Reconstructive Surgery in the Lower Urinary Tract in Children: Can the Complication Rate Be Reduced?

Objective: Reconstructive surgery of the lower urinary tract in children is reported with a high complication rate. The aim was to evaluate the complication rate at our institution. Material and methods: Between 2000 and 2010, 41 boys and 19 girls were consecutively operated on with augmentation with ileum (45), alternative CIC-channel (57) and bladder neck plasty (42) in isolation or as combined procedures in individuals with neurogenic bladder dysfunction NBD (42), bladder exstrophy-epispadias complex BEEC (13), isolated epispadias IE (2) and posterior urethral valves, PUV (3). Median age at surgery was 11 years (range 1.3 -21) and median follow-up time 7 years (1 -10). Complications were consecutively observed at follow-up according to a structured protocol. As first line care, specially trained nurses followed the patients and daily bladder irrigation was included in the CIC follow-up regimen. Results: In individuals with augmentation with ileum, of which all but one performed CIC through an alternative channel, there were stones reported in 3/45 (7%), perforation in 2/45 (4%), reoperation of CIC channel in 5/57 (9%), bowel obstruction in 3/56 (5%) and rupture of BNP in 3/39 (8%). Re-augmentation was not needed and malignancy not found. No significant difference was seen between patients with NBD and BEEC/IE. Conclusion: Complication rates were among the lowest reported for stones, perforation and reoperations of CIC channels and were average for bowel obstruction. Bladder stones and perforation were seen in individuals with bad compliance to recommended CIC-and irrigation regimens.