Bladder outlet procedures (BOP) without augmentation cystoplasty (AC)remain controversial. We hypothesized that BOP without AC may lead to unfavorable bladder dynamics, upper tract changes, and/or continued incontinence.
The goal of this study was to review long term urodynamic, upper tract, and continence outcomes following BOP without AC.
An IRB approved retrospective review was performed of all patients who underwent bladder neck reconstruction/closure/sling without AC from 2000-2014. Because of variation in length of follow up, both cumulative incidence and proportion of patients with upper tract and urodynamic changes, AC, and future continence procedures were calculated. Preoperative factors were compared between patients with and without adverse outcomes.
109 patients underwent BOP without AC at a mean age of8.5 years old. At a mean 4.9 years follow up, 54% (59/109) had undergone additional continence surgery, 18% (20/109) AC, 46% (50/109) developed VUR or hydronephrosis, and 21% (23/109) had newly diagnosed or worsening renal scarring. At time of AC, 72% (13/18) had upper tract changes, 83%(15/18) continued incontinence, and 61% (11/18) EFP >40 cm H2O. All patients had resolution of these changes after AC. Patients who had a vesicostomy or prior surgery for VUR were significantly more likely to undergo a subsequent AC or to develop upper tract changes.
Following BOP without AC, the estimated 10 year cumulative incidence of AC is 30%, continence procedures 70%, upper tract changes >50%, and CKD 20%. Because of these risks, careful patient selection and close follow up is essential if considering BOP without AC.
The Journal of urology 2015 Jul 11 [Epub ahead of print]
Gwen M Grimsby, Vani Menon, Bruce J Schlomer, Linda A Baker, Richard Adams, Patricio C Gargollo, Micah A Jacobs
Children's Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX , Children's Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX , Children's Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX , Children's Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX , University of Texas Southwestern Medical Center, Dallas, TX; Texas Scottish Rite Hospital, Dallas, TX , Texas Children's Hospital, Houston, TX , Children's Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX