Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3240
Peer-review started: March 25, 2020
First decision: April 22, 2020
Revised: May 1, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: August 6, 2020
Augmentation cystoplasty is indispensable in many pediatric diseases, especially neurogenic bladder. Various methods and materials are used to augment the bladder, and these methods are associated with different shortcomings and complications.
The present study reported the mid-term outcomes of patients undergoing various bladder augmentation procedures in a single institution, and assessed whether seromuscular cystoplasty lined with urothelium (SCLU) provided better urodynamic results than auto-augmentation (AA).
A retrospective review of 96 patients undergoing various augmentation methods between 2003 and 2018 was performed. The patients were divided into three groups according to the type of augmentation, and their outcomes were compared. All patients developed neurogenic bladder due to myelomeningocele or sacrococcygeal teratoma. The clinical data of all patients were collected.
The mean ages at surgery in the three groups (standard cystoplasty [SC], SCLU, AA) were 10.8, 7.5, and 4.8 years, respectively, with mean follow-ups of 36, 61, and 36 mo, respectively. The mean preoperative and postoperative bladder capacities of the SC, SCLU, and AA groups were 174 ± 11.7 vs. 387 ± 13.7 (P < 0.0001), 165 ± 12.2 vs. 240 ± 14.7 (P = 0.0002), and 138 ± 16.7 vs. 181 ± 9.9 (P = 0.0360), respectively. Compared with the AA group, the SCLU procedure did not have better postoperative urodynamic parameters. Incontinence was reduced in most patients. The mean times of clean intermittent catheterization per day in the SC, SCLU, and AA groups were 5.6, 7.8, and 8.2, respectively. The main complications of the SC group were recurrent urinary tract infections (8%) and bladder calculi (6%). Re-augmentation was done in patients in the SCLU (8) and AA (3) groups.
SC provided sufficient bladder capacity and improved compliance with acceptable complications. After AA and SCLU, the patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation. Compared with AA, SCLU did not yield better postoperative urodynamic parameters.
Core tip: We performed a retrospective review of the mid-term outcomes of patients undergoing different bladder augmentation procedures for neurogenic bladder in a single institution. We studied a total of 96 patients who underwent one of the following augmentation cystoplasty procedures: Standard cystoplasty (SC), auto-augmentation (AA), and seromuscular cystoplasty lined with urothelium (SCLU). We found that SC provided sufficient bladder capacity and improved compliance with acceptable complications. Bladder capacity and compliance improved with a high rate of re-augmentation after AA and SCLU. Compared with AA, SCLU did not have better postoperative urodynamic parameters.