ESPU Congress 2018 - Abstract Book

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188 29th CONGRESS OF THE ESPU
12:53–12:56
S26-2 (PP)
OUTCOMES OF ORTHOTOPIC PAEDIATRIC NEOBLADDER
RECONSTRUCTION
Alexander CHO, Naima SMEULDERS, Divyesh DESAI, Imran MUSHTAQ, Abraham
CHERIAN and Peter CUCKOW
Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
In the rare situation where native-bladder is unavailable, creation of a neobladder using a composite
of different bowel segments is an option. We present our experience and outcomes with these
patients.
MATERIAL AND METHODS
Retrospective cohort-study of paediatric-patients undergoing orthotopic neobladder reconstruction
(1998–2016). Statistical-Analysis: Wilcoxon Signed-Rank Test.
RESULTS
18-patients (9F:9M); Median-age at reconstruction: 78(27–205) months.
Background:
• Complex cloaca with very small remnant/absent bladder x6
• Rhabdomyosarcoma:Bladder/Prostate x10; Pelvic x1
• Pre-sacral neuroblastoma x1
Operative-Notes:
Segment 1 “Bladder-Plate” Segment 2 Numbers
Sigmoid Distal-Ileum 6
Ileal-Caecum-Ascending Colon n/a 2
Ileal-Conduit (8) Transverse-Colon 1
Sigmoid-Colon & Ileum 3
Distal-Ileum 3
Sigmoid-Colon 1
Colonic-Conduit Mid-Ileum 1
Gastric-Segment Distal-Ileum 1
Mitrofanoff Creation: Appendix 13 (2x in-situ); Ileal-Monti 4; Jejunal-Monti 1
Median stay (days): 11(7–70)
Significant adhesions found intra-operatively x7
Peri-Operative Complications:
• 2x: UTI-sepsis
• 1x Bladder-leak requiring re-operation with subsequent enterocutaneous-fistula requiring
re‑operation & prolonged TPN
Outcomes:
- Median follow-up(months): 57 (9–215)
- Upper-Tracts: Normal x8; Stable x10
- Renal Function: Stable (W-value 9.5, <3 significant). Median GFR pre-op=94, post-op=115.
- Perforation / Secondary Malignancy / Malabsorption – Nil episodes
- Continence:
• Daytime: All dry - 16 pts CIC 3hrly in daytime; 2 patient CIC 3-4x/day