Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20‐year review

Abstract

Background The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. Methods Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999–2019). Short‐ and long‐term outcomes and complications following augmentation cystoplasty were defined. Results Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy‐epispadias complex (30%) and posterior urethral valves (23%). The most common tissue‐type utilized was ileal (58%) and ureteric (30%). Peri‐operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end‐of‐study detrusor pressure improved significantly following bladder augmentation (38–17 cmH2O, P < 0.001). Bladder capacity improved significantly (67–89%, P = 0.041). The median follow‐up was 4.5 years (interquartile range: 1.9–10 years). Bladder urolithiasis affected 13 (18%) patients, and symptomatic urinary tract infections 36 (51%) patients. Formation of a continent catheterisable channel contributed a number of complications relating predominantly to stenosis (50%). Repeat augmentation cystoplasty was necessary in three (4%) cases. Conclusion Augmentation cystoplasty is a surgical intervention that improves bladder metrics. Given the potential complications, careful patient selection and appropriate pre‐operative counselling are essential. Furthermore, pro‐active post‐operative management and transitional care are vital in the surgical care of children following augmentation cystoplasty.

The concerns of mechanical upper urinary tract obstruction in neurogenic lower urinary tract dysfunction: Beyond augmentation cystoplasty

“…The improved VUD parameters, including the MBC, MDP, and bladder compliance, are consistent with previously published data for AC ( 16 – 18 ). The results also demonstrated stable levels of serum creatine during follow-up, indicating preserved renal function.…”

Successful surgical treatment of omphalocele with umbilical evagination of the bladder: an extremely rare presentation of neonatal case

“…Augmentation cystoplasty is a surgical intervention that can significantly and continuously improve the quality of life in children. However, careful patient selection and appropriate preoperative counseling are essential, given the potential complications of urinary leakage and urinary tract stone disease and the fact that augmentation cystoplasty is an independent risk factor for bladder malignancy [ 15 ].…”

2023 Canadian Urological Association/ Pediatric Urologists of Canada guideline: Pediatric patients with neurogenic lower urinary tract dysfunction

“…88 Congregated evidence generated by the NICE and SBA guidelines, as well as recent reports, has shown that augmentation cystoplasty improves bladder capacity and reduced detrusor pressure, decreasing the likelihood of incontinence, specifically in older pediatric patients with NLUTD. 29,40,90,91 Augmentation cystoplasty increases the need for intermittent catheterization; however, it may also improve patient satisfaction and quality of life. 40,91,92 In patients where both augmentation cystoplasty and BTX-A therapy are viable options, analysis shows that augmentation cystoplasty is costeffective for patients likely to benefit from incontinence treatment for more than 10 years.…”