Continent urinary diversion in childhood: complications of alcohol abuse developing in adulthood.

Abstract

PURPOSE: We reviewed the urological sequelae of alcohol abuse in patients following enterocystoplasty in childhood. MATERIALS AND METHODS: We reviewed our patient registry of 385 enteric bladder augmentations. We evaluated patients providing information regarding social habits. Patients were defined as abusing alcohol if they consumed more than 2 alcoholic beverages daily and were compared to a control group consuming 0 to 2 alcoholic beverages daily. RESULTS: A total of 203 patients met inclusion criteria. Of the patients 24 (12%) admitted a history of alcohol abuse, of whom 5 (21%) sustained a total of 10 bladder ruptures, all related to alcohol consumption. All 5 patients presented in a delayed fashion, at more than 12 hours to 5 days following rupture. Despite immediate exploration and repair, 3 separate cardiac resuscitations were performed in 2 patients, of whom 1 died. One patient underwent conversion to an ileal conduit for repeated bladder ruptures (4 episodes) and failure to remain sober following 2 rehabilitation treatments. Three patients maintained long-term sobriety (5 to 9 years) after rehabilitation treatments. CONCLUSIONS: The incidence of alcohol abuse in patients following enterocystoplasty is 12% (24 of 203) and is not different from the reported lifetime risk of 12% to 18% seen in the United States population. Due to the severe consequences of alcohol abuse in patients with enterocystoplasty, we preoperatively instruct all patients that they will have to limit alcohol consumption following the operation and screen via a social history on subsequent followup visits. If a history of alcohol abuse is noted, immediate consultation for rehabilitation is provided.