Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

09:30 - 09:33

S22-6

(PP)

LONG TERM OUTCOMES OF BLADDER NECK RECONSTRUCTION WITHOUT

BLADDER AUGMENTATION FOR NEUROGENIC INCONTINENCE

Gwen GRIMSBY

, Vani MENON

, Bruce SCHLOMER

, Richard ADAMS

, Patricio GARGOLLO

, Linda BAKER

and Micah

JACOBS

1) University of Texas Southwestern Medical Center, Pediatric Urology, Dallas, USA - 2) Texas Scottish Rite Hospital,

Pediatric Developmental Disabilities, Dallas, USA - 3) Baylor College of Medicine, Pediatric Urology, Houston, USA

PURPOSE

To avoid risks associated with augmentation cystoplasty (AC), a bladder neck reconstruction (BNR) may be performed

alone for management of incontinence in patients with neurogenic bladder (NGB). This study reviewed outcomes

following BNR without AC.

MATERIAL AND METHODS

An IRB approved retrospective chart review was performed of all patients with NGB who underwent BNR without AC for

urinary incontinence refractory to CIC and anticholingeric therapy from 2000-2014. Given variable length of follow up,

the cumulative incidence and proportion of patients with hydronephrosis, VUR, renal scarring, CKD diagnosis,

urodynamic findings, AC, and secondary incontinence procedures (additional bladder neck surgery, bladder

neck/catheterizable channel injection, Botox injection) were calculated.

RESULTS

109 patients underwent BNR without AC at a mean age of 8.5 years old (3-18) with a mean follow up of 4.9

years. Table 1 displays the 10 year cumulative incidence of upper tract and urodynamic changes and secondary

surgeries.

Table 1:

10 year cumulative incidence Proportion

Additional Surgery

Continence procedure

70.7% (58.0-83.2%)

59/109 (53.2%)

VUR procedure

35.9% (20.1-58.5%)

19/109 (17%)

Augmentation Cystoplasty

32.2% (20.0-49.2%)

20/109 (18.3%)

Renal Outcomes

VUR/Hydronephrosis

74.6% (58.9-87.9%)

50/109 (45.9%)

Renal scarring

46.1% (30.0%-65.6%)

24/109 (22.0%)

CKD

23.8% (12.8-41.7%)

13/109 (11.9%)

Urodynamic Outcomes

Detrusor EFP >40 cm H2O

79.2% (63.8%-91.2%)

52/109 (47.7%)

Capacity <50% of predicted

85.4% (70.5-95.2%)

61/109 (56.0%)

CONCLUSIONS

Ten years following BNR without AC, an estimated 30% of patients will undergo AC and 70% an additional continence

procedure; over 50% will develop upper tract changes and 20% CKD. Until we can categorize which patients will be at

risk for these morbidities, careful patient selection and close follow up is essential if considering BNR without AC.