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

Abstract

PurposeAugmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children.MethodsA retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables.ResultsRenal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected.ConclusionsWe consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.

Efficacy of Complete Laparoscopic Ileal Augmentation Cystoplasty for the Treatment of Low Bladder Capacity and Compliance: a Case Series

“…The safety and e cacy of augmentation cystoplasty with vascularized gastrointestinal tract have been previously con rmed. The ileum, colon, ileocecum, and stomach can all be used as material for bladder augmentation [5,6], but ileal and sigmoid augmentation cystoplasty are the most common.…”

Efficacy of complete laparoscopic ileal augmentation cystoplasty for the treatment of low bladder capacity and compliance: a case series

“…The safety and efficacy of augmentation cystoplasty with vascularized gastrointestinal tract have been previously confirmed. The ileum, colon, ileocecum, and stomach can all be used as material for bladder augmentation [ 5 , 6 ], but ileal and sigmoid augmentation cystoplasty are the most common.…”

The efficacy of onabotulinumtoxinA in patients with previous failed augmentation cystoplasty: Cohort series and literature review

“…4 The cause of failures are poorly documented. 4,5,17 Patients with immediate symptomatic failure following surgery are presumed to be due to technical failure; either incomplete division of the bladder (residual overactivity in the bladder base) or insufficient bowel interposition to reduce pressure. In our cohort, all but one patient with symptom persistence had single bowel segment augmentation.…”

“…A further smaller cohort of patients may also experience delayed symptom recurrence, sometimes years after an initially successful augmentation. 5,6 In an attempt to limit further interventional surgery, intra-detrusor, and intra-augment onabotulinumtoxinA injections has been employed by clinicians to improve bladder capacity, compliance, and symptoms. However, minimal data is available on the success rates and risks in this patient cohort.…”