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Quality of life: urinary bladder augmentation or substitution in children

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Abstract

Purpose

Bladder augmentation and substitution has been assumed to improve health-related quality of life in patients with urinary incontinence. This study was performed to elicit an evidence base for or against the above hypothesis.

Methods

Between 1988 and 2006, 67 bladder augmentations and 7 bladder substitutions were performed at our institute. Inclusion criteria for the cross-sectional study were a postoperative period of more than 1 year and an age of at least 10 years at the time of operation. A multimodality treatment-specific questionnaire (comprising 38 questions) was designed and sent to 61 patients. Quality of life was investigated in all patients and between the groups of patients with meningomyelocele (Group A) versus bladder exstrophy (Group B), patients, who are catheterizing themselves via urethra (Group C) versus stoma (Group D) and patients who are using (Group E) versus not using wheelchair (Group F) following the surgery. For the statistical analysis Students t test, Wilcoxon signed rank test and correlation analysis were used.

Results

A significant overall improvement was found in patients quality of life following this surgery (P < 0.05). Ninety percent of patients would prefer again bladder augmentation or substitution to their previous state. Patients with meningomyelocele are changing pads or diapers more frequently than exstrophy patients because of their bowel problems postoperatively. Quality of life improved better in patients performing CIC via stoma than in patients who perform it via their native urethra (P < 0.05). Outcomes were independent of patients age and of the post-augmentation time to assessment (P < 0.05).

Conclusions

Bladder augmentation or substitution significantly improved the health-related quality of life in children and young adolescents taking part in the study. The authors are planning a prospective long-term follow-up of the patients (longitudinal study) to validate the results.

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Acknowledgments

This study was supported by the Hungarian Scientific Research Foundation (OTKA T046213) from the Hungarian Academy of Sciences, Hungary. The authors thank Professor Daniel G. Young and Fariborz Bagheri for their assistance in the preparation of the article.

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Authors and Affiliations

  1. Surgical Unit, Department of Paediatrics, Medical School, University of Pecs, 7 Jozsef Attila Street, 7623, Pecs, Hungary

    Peter Vajda, Zoltan Kispal, Andrew Farkas, Attila M. Vastyan & Andrew B. Pinter

  2. Department of Sociology, Faculty of Humanities, University of Pecs, Pecs, Hungary

    Imre Lenart

Authors
  1. Peter Vajda
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  2. Zoltan Kispal
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  3. Imre Lenart
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  4. Andrew Farkas
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  5. Attila M. Vastyan
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  6. Andrew B. Pinter
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Corresponding author

Correspondence to Peter Vajda.

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Vajda, P., Kispal, Z., Lenart, I. et al. Quality of life: urinary bladder augmentation or substitution in children. Pediatr Surg Int 25, 195–201 (2009). https://doi.org/10.1007/s00383-008-2317-3

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