[Growing up with a bladder augmentation].
BACKGROUND
This study assesses long-term outcome of patients with neuropatic bladders who underwent a bladder augmentation before puberty.


METHODS
A total of 21 patients with low compliant neuropathic bladders who did not respond satisfactory to clean intermittent catheterization and/or anticholinergic therapy underwent bladder augmentation (mean age 8.3 yr, range; 2.5-12). Eighteen patients (86%) had VUR and/or ureterohydronephrosis and 17 (81%) had DMSA renal scars. Renal function was normal in all cases except one. All patients were followed at regular intervals with serum electrolyte and creatinine determination, urinary tract imaging, urodynamic evaluation and 24-hour urine collection. In the 18 cases augmented with intestine, urine cytology, cystoscopy and biopsy were also performed.


RESULTS
Mean follow-up was 11 yr (8-14.5) and mean age at the end of follow-up was 19 yr (13.3-26.8). Urodynamic studies showed a significant improvement in bladder compliance. Upper urinary tract dilatation disappeared in all patients, VUR in 13/15p (86%) and no new renal scarring occurred. Renal function was normal at the end of follow-up in 20. Only 1 patient had UTI and another had a bladder stone. All patients are dry and 2 of them do not need clean intermittent catheterization. Urine cytology and cystoscopy were normal and no malignat lessions have been found in the biopsy specimens.


CONCLUSIONS
Bladder augmentation done pre-puberty preserves renal function and resolves VUR and/or hydronephrosis in most cases without reimplanting the ureters. Close lifelong follow-up, including a cystoscopy, improves the results and prevents complications.
López Pereira
P
P
Departamento de Urología Pediátrica, Hospital Infantil La Paz, Madrid.
Espinosa
L
L
Moreno Valle
J A
JA
Alonso Dorrego
J M
JM
Burgos Lucena
L
L
Martínez Urrutia
M J
MJ
Lobato Romera
R
R
Luz Picazo
M
M
Caminoa
A
A
Jaureguízar Monereo
E
E
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000637:transplantation; D008297:Male; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*