Factors Predicting Renal Function Outcome after Augmentation Cystoplasty

Abstract

We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was 7.0 ± 2.6 years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median 114 ± 53.6 to 342.1 ± 68.3 ml (p = .0001), 68.5 ± 19.9 to 28.2 ± 6.9 cm H2O (p = .0001), and 3.0 ± 2.1 to 12.8 ± 3.9 (p = .0001), respectively. Renal function remained stable and improved in 22 (76%) patients from median eGFR 135 ± 81.98 to 142.82 ± 94.4 ml/min/1.73 m2 (p = .160). Significant deterioration was found in 7 (24%) patients from median eGFR 68.25 ± 42 to 36.57 ± 35.33 (p = .001). The causes of renal deterioration were noncompliance to self-catheterization (2 patients), posterior urethral valve/dysplastic kidneys (2 patients), and reflux/infection (2 patients). On multivariate analysis, recurrent pyelonephritis (OR 3.87, p = 0.0155) and noncompliance (OR 30.78, p = 0.0156) were significant. We concluded that AC is not the cause of progression to end-stage renal disease in patients with renal insufficiency.

Voiding dysfunction in children causes, management, and prognosis

“…In our study, iliocystoplasty was carried out in 24 children and 6 have mitrofanoff or monti procedure with no reported major complications and experienced fair preservation of kidney function. Similarly, Mehmood et al, 29 assessed the factors predicting kidney function outcome after augmentation cystoplasty in 41 children, and found the augmentation cystoplasty was not the cause of the progression to ESKD in patients with renal impairment. While Husmann et al, 30 studied the long-term complications following bladder augmentations in 75 patients with spina bifida, deterioration in renal function has been observed in 15%.…”

Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center

“…We consider it likely that these pre-existing conditions contributed to the deterioration in renal function in these patients, rather than the AC. In our previously published case series of 29 adult patients, pre-existing bladder conditions (incomplete emptying, recurrent UTIs, and PUV) were identified as a significant risk factor for the deterioration of renal function after AC [20].…”

Augmentation Cystoplasty in Adult Patients with Renal Impairment

“…Bladder augmentation is described as beneficial in patients with neurological diseases like spinal cord trauma and multiple sclerosis or in severe bladder dysfunction conditions like small capacity, poor compliant bladder with high intravesical pressure which causes vesico-ureteric reflux (VUR) and subsequently renal impairment. [1][2][3] Cystoplasty was mainly indicated as a treatment option for small contracted tuberculous bladder.…”