title: New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder.
abstract: OBJECTIVE
  We report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence.
  
  
  METHODS
  Consecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually.
  
  
  RESULTS
  There were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet).
  
  
  CONCLUSIONS
  Upper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation.
authors.affiliation: UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA. Electronic address: warren.snodgrass@childrens.com.
authors.forename: W
authors.initials: W
authors.lastname: Snodgrass
authors.affiliation: University of Nebraska Medical Center, 988102 Nebraska Medical Center, Omaha, NE 68196-8102, USA. Electronic address: cvillanueva.uro@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Villanueva
authors.affiliation: UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA. Electronic address: patricio.gargollo@childrens.com.
authors.forename: P
authors.initials: P
authors.lastname: Gargollo
authors.affiliation: UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA. Electronic address: micah.jacobs@childrens.com.
authors.forename: M
authors.initials: M
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
keywords: Augmentation; Bladder neck; Hydronephrosis; Neurogenic bladder; Vesicoureteral reflux