title: Upper tract changes in patients with neurogenic bladder and sustained pressures >40 cm following bladder neck surgery without augmentation.
abstract: OBJECTIVE
  We report new hydronephrosis or VUR (vesicoureteral reflux) in patients with end filling pressures >40 cm for at least 1 year after bladder neck surgery without augmentation for neurogenic incontinence.
  
  
  METHODS
  Consecutive children with neurogenic sphincteric incompetency had bladder neck surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually. Those with sustained end fill pressures >40 cm for ≥ 1 year were included as participants in the study.
  
  
  RESULTS
  Of 79 patients, 17 (22%) had end fill pressures >40 cm for at least 1 year despite anticholinergics, with follow-up a mean of 39 months. New hydronephrosis or VUR developed in six (35%). All new hydronephrosis resolved with medical treatment, as did two out of three new VUR cases. The other patient with VUR had successful Dx/HA (dextranomer hyaluronic acid) injection.
  
  
  CONCLUSIONS
  Despite sustained pressures >40 cm, upper tract changes developed in only 35% of patients, and resolved with medical management or minimally invasive interventions. End pressures should not be used as an independent indication for augmentation.
authors.affiliation: Pediatric Urology Section, UT Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA. Electronic address: warren.snodgrass@childrens.com.
authors.forename: Warren
authors.initials: W
authors.lastname: Snodgrass
authors.affiliation: Pediatric Urology Section, UT Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Villaneuva
authors.affiliation: Pediatric Urology Section, UT Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA.
authors.forename: Micah
authors.initials: M
authors.lastname: Jacobs
authors.affiliation: Pediatric Urology Section, UT Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA.
authors.forename: Patricio
authors.initials: P
authors.lastname: Gargollo
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D018579:Patient Selection; D011312:Pressure; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology* / Q000628:therapy
chemical_list: D008333:Mandelic Acids; D018727:Muscarinic Antagonists; C005419:oxybutynin
keywords: Bladder neck sling; Bladder neck surgery; Detrusor leak point pressure; Neurogenic bladder