title: Detrusorectomy reduces the need for augmentation and use of antimuscarinics in children with neuropathic bladders.
abstract: OBJECTIVE
  To assess bladder behaviour and long-term outcome after detrusorectomy in children.
  
  
  METHODS
  Between 1990 and 2001, 49 detrusorectomies were performed (mean follow-up: 9.6 years) in children with neuropathic bladders (mean age at surgery: 9.8 years). Urodynamic study (UDS) was done before surgery (pre-UDS) and after surgery (UDS-1 and UDS-2). Bladder behaviour was assessed as good, fair or poor depending on the volume and intravesical pressure. In all patients, oxybutynin and clean intermittent catheterization were used preoperatively. In 24 patients, good bladder compliance and capacity were seen before detrusorectomy.
  
  
  RESULTS
  Good and fair outcomes were observed in 35 (71%) patients at 1 year and in 39 (79%) patients 6 years after detrusorectomy. In 30 (60%) patients, there was hardly any difference between the first and second follow-up. In 9 (18%) patients, formal bowel bladder augmentation was necessary: in 6 (12%) because of poor compliance and in 3 because of small bladder volume and incontinence. Seven patients improved during follow-up, 5 of them after resuming oxybutynin. In 11 patients, oxybutynin could be stopped, and in 2 the dosage could be reduced to once daily.
  
  
  CONCLUSIONS
  The good short-term results of detrusorectomy generally remain unchanged at long-term follow-up. Detrusorectomy can reduce the need for antimuscarinics, and the need for formal bladder augmentation in selected cases.
authors.affiliation: Paediatric Urology Centre WKZ Utrecht/EKZ Amsterdam, Department of Paediatric Urology, University Children's Hospital AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.chrzan@amc.nl
authors.forename: Rafal
authors.initials: R
authors.lastname: Chrzan
authors.forename: Pieter
authors.initials: P
authors.lastname: Dik
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Klijn
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Kuijper
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D009122:Muscle Hypertonia / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods; D014549:Urinary Incontinence / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics; D013520:Urologic Surgical Procedures
chemical_list: D008333:Mandelic Acids; D018727:Muscarinic Antagonists; C005419:oxybutynin