Autoaugmentation versus enterocystoplasty: Outcomes in myelodysplastic children with neurogenic bladder

ABSTRACT

OBJECTIVE: Bladder autoaugmentation with detrusorectomy is done to improve bladder capacity and compliance in neurogenic bladders, to achieve constant low bladder pressure, preventing sequelae such as renal failure. Some reports discourage its application however citing that effects are short term and failure rates are high. We compared the pre and post-operative urodynamic profile of high risk patients undergoing autoaugmentation or enterocystoplasty to determine if it can still be used as a treatment option for neurogenic bladders. MATERIALS AND METHODS: A retrospective study using the database of our spina bifida foundation was performed. Out of 382 patients, 45 underwent augmentation cystoplasty. Twenty seven (27) had followed evaluation protocol and were included in the study. The median age was 8.6 years at the time of surgery and the median years of follow up was 3.5 years. Urodynamic parameters, as well as symptom and bladder/sphincter profiles, pre- and post-operatively were compared between the two groups. RESULTS: In the autoaugmentation group there was a 42.45% mean increase in capacity, and mean increase in compliance of 181.1% versus a 190.3% increase in capacity, and 479% increase in compliance in the enterocystoplasty group. The difference is statistically significant. There was no difference in the end filling pressure, leak point pressures, reflux, number of postoperative UTIs and incontinence. One patient in the autoaugmentation needed redo with an enterocystoplasty. Complication rates were comparable in both groups. CONCLUSION: Autoaugmentation cystoplasty is still a viable option for surgical management of neurogenic bladders. Our data showed that in patients who underwent detrusorectomy, there was improvement of urodynamic parameters, bladder and upper tract profiles, UTIs and incontinence, which were comparable to the gold standard.