title: Is long-term bladder deterioration inevitable following successful isolated bladder outlet procedures in children with neuropathic bladder dysfunction?
abstract: OBJECTIVE
  Bladder decompensation is well described following artificial urinary sphincter implantation in neurogenic bladders. We evaluated the long-term results of various bladder outlet procedures in a subset of patients with neurogenic bladder and isolated outlet deficiency.
  
  
  METHODS
  We retrospectively reviewed the charts of 15 consecutive patients who underwent bladder outlet procedures during a 10-year period for urinary incontinence associated with neuropathic bladder dysfunction. Postoperative success was defined as a dry interval of at least 4 hours.
  
  
  RESULTS
  Preoperative evaluation showed a smooth bladder in 11 patients with vesicoureteral reflux and hydronephrosis in 2. Using the minimal acceptable capacity for age, mean percent expected bladder capacity for age was 89% +/- 25%, capacity below 20 cm H(2)O was 81% and capacity below 30 cm H(2)O was 89%. Mean preoperative expected capacity for age was 60% +/- 18%. Mean postoperative followup was 11.2 years. Postoperatively, 11 patients achieved initial dryness but 9 subsequently presented with recurrent incontinence and 2 presented with upper tract deterioration. Four cases failed the initial bladder outlet procedure. Salvage procedures included augmentation cystoplasty in all 15 patients, combined with repeat bladder outlet procedure in 4 and bladder neck closure in 2. Mean time to augmentation cystoplasty was 39.6 +/- 28 months.
  
  
  CONCLUSIONS
  Isolated bladder outlet procedures for neurogenic incontinence portend a poor long-term outcome, requiring augmentation cystoplasty despite the use of anticholinergic medications and strict followup. Preoperative urodynamic evaluation does not predict the need or timing from the initial bladder outlet procedure for future augmentation cystoplasty.
authors: Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors: Sumit
authors: S
authors: Dave
authors: Joao L
authors: JL
authors: Pippi Salle
authors: Armando J
authors: AJ
authors: Lorenzo
authors: Luis H P
authors: LH
authors: Braga
authors: Maria Helena
authors: MH
authors: Peralta-Del Valle
authors: Darius
authors: D
authors: Bägli
authors: Antoine E
authors: AE
authors: Khoury
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001743:Urinary Bladder / Q000503:physiopathology* / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects*