Purpose: To evaluate the midterm outcomes of protection for upper urinary tract (UUT) function by augmentation enterocystoplasty (AE) using a grading system for upper urinary tract dilation (UUTD) and a descriptive system for all urinary tract dysfunction (AUTD) in patients with neurogenic bladder.
Methods: We retrospectively reviewed 120 cases of AE from our database, which was collected between 2005 and 2013. UUTD grading system was developed by magnetic resonance urography (MRU), and AUTD system was described by video-urodynamics, MRU, isotope renography, etc. UUT function was evaluated by these systems before operation, and at 6, 12, 24 and 36 months postoperatively. The indication, midterm outcomes and complications were evaluated.
Results: All patients had significant improvement for urodynamic parameters at 6 months postoperatively. Comparing the grades of UUTD and vesicoureteral reflux (VUR) before and after operation, the median grade of 95 UUTD ureters decreased from 3 to 0, and the percentage of 0 grade UUTD increased from 0 to 90.9 % at 36 months. The median grade of 96 VUR ureters decreased from 3 to 0, and the percentage of 0 grade VUR increased from 0 to 98.6 % at 36 months. The glomerular filtration rate of kidneys and serum creatinine level of patients had an increasing improvement after surgery.
Conclusions: The midterm follow-up using UUTD and AUTD systems indicates that AE is effective and safe for UUT protection. The patients with moderate and severe UUT deteriorations and renal function impairment resulting from VUR and UUTD have undergone the increasing improvement.