Enterocystoplasty in childhood: a second look at the effect on growth
Article first published online: 7 JAN 2003
Volume 91, Issue 1, pages 79–83, January 2003
How to Cite
Gerharz, E.W., Preece, M., Duffy, P.G., Ransley, P.G., Leaver, R. and Woodhouse, C.R.J. (2003), Enterocystoplasty in childhood: a second look at the effect on growth. BJU International, 91: 79–83. doi: 10.1046/j.1464-410X.2003.04012.x
- Issue published online: 7 JAN 2003
- Article first published online: 7 JAN 2003
- Accepted for publication 30 September 2002
- linear growth;
- urinary diversion;
- bladder exstrophy;
- bone metabolism
To re-evaluate the assumption that enterocystoplasty in children has a detrimental effect on linear growth (which is almost exclusively based upon a chance finding in a retrospective study 10 years ago) in a larger cohort and with a longer follow-up.
PATIENTS AND METHODS
The original 12 children who had impaired linear growth in a previous study 10 years earlier were re-measured. A larger cohort was identified from the 242 children and adolescents who had undergone enterocystoplasty between 1982 and 1997. Patients with conditions involving organ systems apart from the urinary tract, and those with myelomeningocele, malignant diseases, reduced glomerular filtration rate and incomplete notes were excluded. In the definitive study cohort (123; mean age at operation 8.6 years; mean age at investigation 16.8 years) enterocystoplasty had been undertaken using colon in 70, ileum in 37, a combination of both in 11, ileocaecal segments in three and stomach in two patients.
Of the original 12 patients, six had regained or surpassed their preoperative position on their growth charts. In all patients with a known target centile range the final height was within their genetic growth potential. In the cohort of 123 patients, 1215 height and weight measurements had been recorded. The distribution of percentile positions before and after enterocystoplasty showed a normal configuration, with 83% and 80% of patients growing within two standard deviations of the 50th percentile. After surgery, 85% either remained on the same or reached a higher centile. Nineteen (15.5%) were in a lower position, with a similar tendency in the weight centile. A clinically relevant growth disorder was recognized in four patients with a complete endocrinological evaluation; in none of these was enterocystoplasty thought to be a causal factor.
It is very unlikely that the loss of the preoperative percentile position on the growth curve in 15% of children after enterocystoplasty is a consequence of the surgery. Rather it is a non-specific phenomenon that has to be considered in any clinical population of the same size and age distribution after the same length of time.