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

S22-11

(P)

URODYNAMIC PREDICTORS OF ADVERSE OUTCOMES AFTER BLADDER NECK

RECONSTRUCTION WITHOUT AUGMENTATION CYSTOPLASTY

Vani MENON

, Gwen GRIMSBY

, Bruce SCHLOMER

, Patricio GARGOLLO

, Richard ADAMS

, Linda BAKER

and Micah

JACOBS

1) University of Texas - Dallas, Southwestern, Pediatric Urology, Dallas, USA - 2) Baylor College of Medicine, Pediatric

Urology, Houston, USA - 3) Texas Scottish Rite Hospital, Pediatric Developmental Disabilities, Dallas, USA

PURPOSE

Bladder neck reconstruction (BNR) without augmentation cystoplasty (AC) for children with neurogenic bladder is

controversial. Adverse outcomes include additional procedures for incontinence or upper tract changes such

hydronephrosis, vesicoureteral reflux, and renal scarring. This study evaluated pre-operative urodynamic parameters as

predictors of additional incontinence surgery, AC, or upper tract changes after BNR without AC.

MATERIAL AND METHODS

An IRB approved retrospective database was created for children who underwent BNR without AC from 2000-

2014. Subsequent incontinence surgery, AC, and upper tract changes were identified. Preoperative urodynamic

parameters including compliance, percentage predicted capacity (PPC), and detrusor end fill pressure (EFP) were

compared between those with and without adverse outcomes using Wilcoxon rank sum, Fisher’s exact test, and cox

proportional hazards. PPC was calculated as estimated capacity [(age+2)x30] divided by actual capacity.

RESULTS

Preoperative urodynamic data was available in 106/109 patients. Post BNR without AC, 59/109 had subsequent

continence surgery, 20/109 underwent AC, 50/109 developed VUR or hydronephrosis, and 24/109 had renal

scarring. Preoperative PPC was lower in the group with renal scarring (57% vs. 70%, p=0.049; HR = 0.4, 95% CI 0.1-

1.5) as was bladder compliance (10.5 vs 18.8, p=0.03; HR = 0.7, 95% CI 0.5-1.1). No children (0/15) with compliance

≥ 30 mL/cmH20 underwent AC compared to 19/91 (20%) with compliance < 30 mL/cmH2O (p=0.067). There were no

preoperative urodynamic parameters associated with additional continence surgery.

CONCLUSIONS

Preoperative compliance is associated with renal scarring in patients undergoing BNR without AC. In addition, no

patients with a compliance ≥30mL/cmH20 underwent subsequent AC.