title: Promising long-term outcome of bladder autoaugmentation in children with neurogenic bladder dysfunction.
abstract: OBJECTIVE
  We evaluated the long-term outcome of bladder autoaugmentation in children with neurogenic bladder dysfunction.
  
  
  METHODS
  Data were compiled from the records of 25 children with a median age of 9.3 years (range 0.9 to 14.2) who underwent detrusor myotomy between 1992 and 2008. All patients were diagnosed with small bladder capacity, low compliance and high end filling pressures, and were unresponsive to clean intermittent catheterization and anticholinergics.
  
  
  RESULTS
  Median followup was 6.8 years (range 0.1 to 15.6). Median postoperative bladder capacity was unchanged or decreased to 95 ml (range 25 to 274) during the first 3 months compared to a median preoperative capacity of 103 ml (14 to 250). At 5 months postoperatively median bladder capacity increased significantly to 176 ml (range 70 to 420, p<0.01). This increase remained significant during the rest of followup. Median bladder compliance doubled after 1 year to 10 ml/cm H2O (range 1 to 31, p<0.05) compared to the preoperative level, and further increased to 17 ml/cm H2O (5 to 55) at 5 years (p<0.05). Median maximal detrusor pressure was 43 cm H2O (range 8 to 140) preoperatively. This value decreased significantly postoperatively (p<0.01) and at final followup it was 26 cm H2O (range 6 to 97). Kidney function developed normally in all patients except 1 with persistent uremia. Reflux was alleviated in 7 of 9 cases. Of the patients 18 became continent on clean intermittent catheterization.
  
  
  CONCLUSIONS
  Bladder autoaugmentation in children with neurogenic bladder dysfunction offers, after a transient decrease in bladder capacity, a long lasting increase in capacity and compliance, while the end filling pressure decreases.
authors.affiliation: Department of Urology, Aarhus University Hospital Skejby, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Eva Lund
authors.initials: EL
authors.lastname: Hansen
authors.forename: Gitte Møller
authors.initials: GM
authors.lastname: Hvistendahl
authors.forename: Yazan F H
authors.initials: YF
authors.lastname: Rawashdeh
authors.forename: L Henning
authors.initials: LH
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D011184:Postoperative Period; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: CIC; DM; EBC; LPP; UTI; VUR; child; clean intermittent catheterization; detrusor myotomy; expected bladder capacity; leak point pressure; reconstructive surgical procedures; surgical flaps; urinary bladder; urinary tract infection; vesicourethral reflux