Surgical outcomes of bladder augmentation: A comparison of three different augmentation procedures

Xiao-Gang Sun; Ruo-Yi Wang; Jia-Long Xu; Dian-Guo Li; Wei-Xiu Chen; Jin-Liang Li; Jian Wang; Ai-Wu Li

doi:10.12998/wjcc.v8.i15.3240

Surgical outcomes of bladder augmentation: A comparison of three different augmentation procedures

World J Clin Cases. 2020 Aug 6;8(15):3240-3248. doi: 10.12998/wjcc.v8.i15.3240.

Authors

Xiao-Gang Sun¹, Ruo-Yi Wang², Jia-Long Xu², Dian-Guo Li², Wei-Xiu Chen², Jin-Liang Li², Jian Wang¹, Ai-Wu Li³

Affiliations

¹ Department of Pediatric Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China.
² Department of Pediatric Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China.
³ Department of Pediatric Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China. 18753107030@163.com.

Abstract

Background: 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.

Aim: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Augmentation cystoplasty; Auto-augmentation; Child; Neurogenic bladder; Surgery; Urodynamics.