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

Introduction 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. Objective We assessed the risk of long-term surgical complications in pediatric patients with IV at a single children's hospital. Study design 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 (DGFR) and Society of Fetal Urology (DSFU) hydronephrosis from the time of surgery to last follow up. Results 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 f 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 DSFU grade from the time of surgery to last follow up was-1.24 f 1.48 and mean DGFR was-2.5 f 32.7 ml/ min. Discussion 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. Conclusion 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.