Long-term surgical outcomes of ileovesicostomy at a single children's hospital

• Published in: Journal of pediatric urology
• Main Authors: Flores, Viktor X., Frainey, Brendan, Mikhael, Matthew, Abelson, Benjamin N., Li, Belinda, Chen, Heidi, Adams, Cyrus M., Taylor, Abby S., Thomas, John C., Pope, John C., Adams, Mark C., Brock, John W., Clayton, Douglass B.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 02-11-2024
• Subjects: Augmentation cystoplasty; Ileovesicostomy; Neurogenic bladder; Reconstruction; Reconstruction; SBO; AC; CCC; SFU; LUTR; Augmentation cystoplasty; Ileovesicostomy; IV; GFR; VUR; BNC; SPT; Neurogenic bladder; VPS; CIC
• ISSN: 1477-5131; 1873-4898; 1873-4898
• DOI: 10.1016/j.jpurol.2024.10.028

The ileovesicostomy (IV) is a surgical option for patients with refractory bladder dysfunction at-risk of upper tract deterioration who cannot catheterize or lack social support for managing an augmentation cystoplasty (AC). Long-term outcomes after IV in children are lacking in the literature.
We assessed the risk of long-term surgical complications in pediatric patients with IV at a single children's hospital.
We retrospectively reviewed the records of patients undergoing IV between 2002 and 2021 at a single children's hospital. The primary outcome was the rate of surgical complications in IV patients after initial reconstruction. Specific complications of interest included intra-abdominal, reservoir, and stomal complications, respectively. We also assessed renal outcomes, including the change in glomerular filtration rate (ΔGFR) and Society of Fetal Urology (ΔSFU) hydronephrosis from the time of surgery to last follow up.
The study comprised 17 IV patients, with most patients having a diagnosis of spina bifida (65 %). Median follow-up was 6.4 years. The mean rate of surgical complications per patient year was 0.11 ± 0.20. On survival analysis, the time to first complication for IV was 84.4 months. The incidence of intra-abdominal, reservoir, and stomal complications over the study period was 2/17 (11.8 %) for each of these complication types. The mean ΔSFU grade from the time of surgery to last follow up was −1.24 ± 1.48 and mean ΔGFR was −2.5 ± 32.7 ml/min.
We found that IV in pediatric patients experience a low rate (0.11/year) of complications and that median time to first complication was 84 months. Additionally, IV offers adequate renal preservation. Our study is limited, though, by its retrospective nature, small sample size, heterogenous population and lack of comparison group.
Our experience demonstrates that IV has a low rate of surgical complications and preserves renal function. We believe it is a reasonable surgical option for the well selected patient with refractory bladder dysfunction at-risk of upper tract deterioration who is unable to reliably catheterize.