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Sub-urothelial polyp enucleation resection and urothelial auto-augmentation cystoplasty: a simple method for bladder exstrophy–epispadias complex reconstruction in bladder plate polyposis

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Abstract

Objectives

To report the results of a novel technique of sub-urothelial polyp enucleation resection (SUPER) and urothelial auto-augmentation cystoplasty (UAAC) in patients with bladder exstrophy and polyposis plate.

Methods

Twenty-eight patients with bladder exstrophy covered by plate polyposis were referred for further management. From these, 12 patients had undergone SUPER, UAAC technique, and subsequent bladder closure. In this technique, the urothelium covering the polyps was utilized as tissue for auto-augmentation cystoplasty. Sixteen patients had been operated by simple polyps’ excision and bladder closure. Biopsies of polyps were obtained in both groups at the time of closure for pathological evaluations. The bladder plate was measured pre-and post-bladder plate augmentation. The patients were evaluated every 3 months for 1 year and biannually thereafter for urinary continence and social dryness. Dry period of >3 h during the day with or without nocturnal incontinence was defined as social dryness.

Results

All patients experienced an uneventful postoperative period. No sign of metaplasia or dysplasia was observed in the histological and cystoscopy evaluations. These findings suggest that neither polyp recurrence nor bladder tumor development has occurred in any of the groups. The urinary continence improved significantly in the polyp’s urothelial coverage augmentation cystoplasty technique (66.7 %), while 31.3 % of patients in simple closure technique achieved continence. Significantly higher mean bladder capacity was obtained in the augmentation group (190 ± 38 ml) and (119 ± 21 ml), respectively. Postoperative mild hydronephrosis and vesicoureteral reflux were significantly lower in auto-augmentation technique.

Conclusion

The final clinical outcome of children with bladder exstrophy polyposis is promising. The combined SUPER and UAAC technique is feasible, safe and reproducible option for bladder exstrophy–epispadias complex (BEEC) patients with bladder plate polyposis. However, it will add one supplementary operation to the single or staged bladder reconstruction. These patients may warrant further surveillance with histopathological evaluations during the adult life.

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Abbreviations

SUPER:

Sub-urothelial polyp enucleation resection

UAAC:

Urothelial auto-augmentation cystoplasty

BEEC:

Bladder exstrophy–epispadias complex

FBC:

Failed bladder closure

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Acknowledgments

We highly appreciate Mrs. Farahnaz Bayat’s assistance for her artistic illustrations. We also appreciate Mr. Majid Kajbafzadeh at the School of Population and Public Health, Faculty of Medicine University of British Columbia, Vancouver, Canada, for his valuable final linguistic revision of the manuscript. We are highly grateful to Mrs. S. Lotfi for her precise pre-submission final linguistic revision of the manuscript.

Conflict of interest

No conflict of interest exists in relation to the submitted manuscript and there was no source of extra-institutional commercial funding or funding received from National Institutes of Health (NIH), Welcome Trust, Howard Hughes Medical Institute (HHMI) and others.

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Authors and Affiliations

  1. Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib’s Street, Keshavarz Boulevard, 1419433151, Tehran, Islamic Republic of Iran

    Abdol-Mohammad Kajbafzadeh, Ali Tourchi & Nastaran Sabetkish

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  1. Abdol-Mohammad Kajbafzadeh
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  2. Ali Tourchi
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  3. Nastaran Sabetkish
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Correspondence to Abdol-Mohammad Kajbafzadeh.

Appendix

Appendix

See Table 2.

Table 2 Questionnaire for grading of incontinence
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Kajbafzadeh, AM., Tourchi, A. & Sabetkish, N. Sub-urothelial polyp enucleation resection and urothelial auto-augmentation cystoplasty: a simple method for bladder exstrophy–epispadias complex reconstruction in bladder plate polyposis. Pediatr Surg Int 30, 669–676 (2014). https://doi.org/10.1007/s00383-014-3510-1

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