Subscribe to RSS
Autoaugmentation: A Feasible Option before Ileal Augmentation in Selected Cases
Purpose To evaluate the long-term outcomes of autoaugmentation (AA) in pediatric population.
Materials and Methods The data of 59 patients (32 females and 27 males) who underwent AA between 1993 and 2018 were analyzed retrospectively. During postoperative follow-up, deterioration on renal scan and/or nonimproved hydronephrosis (HN) were described as upper urinary tract (UUT) impairment. Incontinence was described as use of diaper or pad. Preoperative urodynamic volume was divided into two as less than 50 and more than or equal to 50% expected bladder capacity (EBC). The effect of preoperative clinical factors on reaugmentation, incontinence, and UUT impairment was evaluated.
Results The mean age and the median follow-up were 8.9 ± 3.6 years and 64 (12–218) months, respectively. Ten (16.9%) patients underwent reaugmentation (ureteral or ileal). UUT impairment and incontinence rates were 13.6% (8/59) and 30.5% (18/59), respectively. On multivariate analysis, less than 50% EBC was the only predictor of reaugmentation and incontinence (p = 0.013, odds ratio [OR]: 17.546 and p = 0.035, OR: 3.750, respectively). Preoperative HN was predictor of UUT impairment (p = 0.041, OR: 10.168). After AA, 51 patients used clean intermittent catheter and 27 (45.8%) patients discontinued the use of anticholinergic medication. At follow-up, eight (13.5%) patients underwent surgery after AA due to long-term complications, dissatisfaction, or poor functional results (bladder neck injection, cystolithotripsy, Mitrofanoff revision, dilatation, and injection).
Conclusion AA is a viable option in selected cases with high pressure and low compliant bladders. Preoperative bladder capacity is significant for reaugmentation rate and continence. UUT impairment is related to preoperative HN.
Received: 04 April 2021
Accepted: 01 October 2021
25 November 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Metcalfe PD, Rink RC. Bladder augmentation: complications in the pediatric population. Curr Urol Rep 2007; 8 (02) 152-156
- 2 Flood HD, Malhotra SJ, O'Connell HE, Ritchey MJ, Bloom DA, McGuire EJ. Long-term results and complications using augmentation cystoplasty in reconstructive urology. Neurourol Urodyn 1995; 14 (04) 297-309
- 3 Sountoulides P, Laguna PJ, de la Rosette J. Complications following augmentation cystoplasty, prevention and management. Cent European J Urol 2009; 62: 216-221
- 4 Hensle TW, Bingham J, Lam J, Shabsigh A. Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol. BJU Int 2004; 93 (04) 585-587
- 5 Gilbert SM, Hensle TW. Metabolic consequences and long-term complications of enterocystoplasty in children: a review. J Urol 2005; 173 (04) 1080-1086
- 6 Austin JC, Elliott S, Cooper CS. Patients with spina bifida and bladder cancer: atypical presentation, advanced stage and poor survival. J Urol 2007; 178 (3 Pt 1): 798-801
- 7 MacNeily AE, Afshar K, Coleman GU, Johnson HW. Autoaugmentation by detrusor myotomy: its lack of effectiveness in the management of congenital neuropathic bladder. J Urol 2003;170(4 Pt 2):1643–1646, discussion 1646
- 8 Lindley RM, Mackinnon AE, Shipstone D, Tophill PR. Long-term outcome in bladder detrusorectomy augmentation. Eur J Pediatr Surg 2003; 13 (Suppl. 01) S7-S12
- 9 Hansen EL, Hvistendahl GM, Rawashdeh YF, Olsen LH. Promising long-term outcome of bladder autoaugmentation in children with neurogenic bladder dysfunction. J Urol 2013; 190 (05) 1869-1875
- 10 Chrzan R, Dik P, Klijn AJ, Kuijper CF, de Jong TP. Detrusorectomy reduces the need for augmentation and use of antimuscarinics in children with neuropathic bladders. J Pediatr Urol 2013; 9 (02) 193-198
- 11 Medical versus surgical treatment of primary vesicoureteral reflux: a prospective international reflux study in children. J Urol 1981; 125 (03) 277-283
- 12 Ceriotti F, Boyd JC, Klein G. et al; IFCC Committee on Reference Intervals and Decision Limits (C-RIDL). Reference intervals for serum creatinine concentrations: assessment of available data for global application. Clin Chem 2008; 54 (03) 559-566
- 13 Puri A, Bhatnagar V, Grover VP, Agarwala S, Mitra DK. Urodynamics-based evidence for the beneficial effect of imipramine on valve bladders in children. Eur J Pediatr Surg 2005; 15 (05) 347-353
- 14 Samuel M, Boddy SA, Wang K. What happens to the bladder at night? Overnight urodynamic monitoring in children with neurogenic vesical dysfunction. J Urol 2001; 165 (6 Pt 2): 2335-2340
- 15 Hackler RH, Hall MK, Zampieri TA. Bladder hypocompliance in the spinal cord injury population. J Urol 1989; 141 (06) 1390-1393
- 16 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250 (02) 187-196
- 17 Riccabona M, Koen M, Schindler M. et al. Botulinum-A toxin injection into the detrusor: a safe alternative in the treatment of children with myelomeningocele with detrusor hyperreflexia. J Urol 2004;171(2 Pt 1):845–848, discussion 848
- 18 Husmann DA, Snodgrass WT, Koyle MA. et al. Ureterocystoplasty: indications for a successful augmentation. J Urol 2004; 171 (01) 376-380
- 19 Youssif M, Badawy H, Saad A, Hanno A, Mokhless I. Augmentation ureterocystoplasty in boys with valve bladder syndrome. J Pediatr Urol 2007; 3 (06) 433-437
- 20 Elbahnasy AM, Shalhav A, Hoenig DM, Figenshau R, Clayman RV. Bladder wall substitution with synthetic and non-intestinal organic materials. J Urol 1998; 159 (03) 628-637
- 21 McNamara ER, Kurtz MP, Schaeffer AJ, Logvinenko T, Nelson CP. 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis. J Pediatr Urol 2015; 11 (04) 209.e1-209.e6
- 22 Telli O, Ozcan C, Hamidi N. et al. Preoperative risk factors predicting complication rates of augmentation cystoplasty using the modified Clavien classification system in pediatric population. Urology 2016; 97: 166-171
- 23 Metcalfe PD, Cain MP, Kaefer M. et al. What is the need for additional bladder surgery after bladder augmentation in childhood?. J Urol 2006;176(4 Pt 2):1801–1805, discussion 1805
- 24 Shekarriz B, Upadhyay J, Demirbilek S, Barthold JS, González R. Surgical complications of bladder augmentation: comparison between various enterocystoplasties in 133 patients. Urology 2000; 55 (01) 123-128
- 25 Cartwright PC, Snow BW. Bladder autoaugmentation: early clinical experience. J Urol 1989;142(2 Pt 2):505–508, discussion 520–521
- 26 Nguyen DH, Mitchell ME, Horowitz M, Bagli DJ, Carr MC. Demucosalized augmentation gastrocystoplasty with bladder autoaugmentation in pediatric patients. J Urol 1996; 156 (01) 206-209
- 27 Lima SV, Araujo LA, Vilar FdeO, Lima RS, Lima RF. Nonsecretory intestinocystoplasty: a 15-year prospective study of 183 patients. J Urol 2008; 179 (03) 1113-1116 , discussion 1116–1117
- 28 Dewan PA, Close CE, Byard RW, Ashwood PJ, Mitchell ME. Enteric mucosal regrowth after bladder augmentation using demucosalized gut segments. J Urol 1997; 158 (3 Pt 2): 1141-1146