New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder |
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| Institution: | 1. UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA;2. University of Nebraska Medical Center, 988102 Nebraska Medical Center, Omaha, NE 68196-8102, USA;1. Division of Pediatric Urology, Arkansas Children''s Hospital, Little Rock, AR, USA;2. Division of Surgery, Arkansas Children''s Hospital, Little Rock, AR, USA;3. University of Arkansas for Medical Sciences, College of Medicine, 4301 W. Markham, Little Rock, AR 72205, USA;4. Division of Radiology, Arkansas Children''s Hospital, Little Rock, AR, USA;1. Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, TN, USA;2. Department of Anesthesiology, Vanderbilt University School of Medicine & Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, TN, USA;3. Department of Pediatrics, Vanderbilt University School of Medicine & Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, TN, USA;4. Perioperative Services & Pediatric Pain Service, Vanderbilt University Medical Center & Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, TN, USA |
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| Abstract: | ObjectiveWe report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence.Materials and methodsConsecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually.ResultsThere were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet).ConclusionsUpper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation. |
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| Keywords: | Bladder neck Augmentation Vesicoureteral reflux Hydronephrosis Neurogenic bladder |
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