THE LONG-TERM EFFECT OF BLADDER AUGMENTATION ON RENAL FUNCTION
BAUS ePoster online library. Frost A. 06/25/19; 259565; P7-10
Anastasia Frost
Anastasia Frost
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Abstract
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INTRODUCTION

This study examines the long-term effect of augmentation cystoplasty on kidney function, and predicts which patients are more likely to have deteriorating renal function over time.

METHODS

276 patients (mean age 23.7years) underwent augmentation cystoplasty between 1981 and 2004. 169 had adequate follow-up (mean 25 years;range10-32years). Renal function was measured as estimated glomerular filtration rate(eGFR), recorded at 5-year intervals.

RESULTS

119 had congenital bladder disorders; spina bifida(SB) n=100, congenital anatomical anomalies(CAA) mainly exstrophy-related n=19. 50 had acquired bladder dysfunction(ABD). At the time of surgery, mean age of SB patients was 18.5 years(4.3–48.7 years), CAA 18.4 years(3.8–43.6 years), ABD 36.5 years(3.7–73 years). Ileocystoplasty was performed in 134 patients, caecocystoplasty in 27, colocystoplasty in 8.

Overall, renal function declined by 22.8ml/min over 30 years. This is in line with the physiological decline of 0.75ml/min/year in healthy individuals. The decline in eGFR in ABD was 34ml/min, CAA 18ml/min and 5.7ml/min in SB. In patients aged 0–19years at time of operation(n=89) the fall in eGFR was 20.5ml/min; 29.3ml/min in those aged 40–59years (n=25). In ileocystoplasty, overall GFR decline over 30 years was 18.5ml/min; 31ml/min with colocystoplasty. 3(1.8%) patients had a kidney transplant and 4(2.4%) had a nephrectomy over the 30years studied.

CONCLUSION

Patients with ABD show a more marked decline in renal function, related to their older age, and reduced renal function at time of surgery. Pre-op renal function, aetiology,age and bowel segment used are important factors when counselling patients regarding life-time decline in renal function following augmentation cystoplasty.
INTRODUCTION

This study examines the long-term effect of augmentation cystoplasty on kidney function, and predicts which patients are more likely to have deteriorating renal function over time.

METHODS

276 patients (mean age 23.7years) underwent augmentation cystoplasty between 1981 and 2004. 169 had adequate follow-up (mean 25 years;range10-32years). Renal function was measured as estimated glomerular filtration rate(eGFR), recorded at 5-year intervals.

RESULTS

119 had congenital bladder disorders; spina bifida(SB) n=100, congenital anatomical anomalies(CAA) mainly exstrophy-related n=19. 50 had acquired bladder dysfunction(ABD). At the time of surgery, mean age of SB patients was 18.5 years(4.3–48.7 years), CAA 18.4 years(3.8–43.6 years), ABD 36.5 years(3.7–73 years). Ileocystoplasty was performed in 134 patients, caecocystoplasty in 27, colocystoplasty in 8.

Overall, renal function declined by 22.8ml/min over 30 years. This is in line with the physiological decline of 0.75ml/min/year in healthy individuals. The decline in eGFR in ABD was 34ml/min, CAA 18ml/min and 5.7ml/min in SB. In patients aged 0–19years at time of operation(n=89) the fall in eGFR was 20.5ml/min; 29.3ml/min in those aged 40–59years (n=25). In ileocystoplasty, overall GFR decline over 30 years was 18.5ml/min; 31ml/min with colocystoplasty. 3(1.8%) patients had a kidney transplant and 4(2.4%) had a nephrectomy over the 30years studied.

CONCLUSION

Patients with ABD show a more marked decline in renal function, related to their older age, and reduced renal function at time of surgery. Pre-op renal function, aetiology,age and bowel segment used are important factors when counselling patients regarding life-time decline in renal function following augmentation cystoplasty.

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