title: Mortality after bladder augmentation in children with spina bifida.
abstract: OBJECTIVE
  Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with bladder augmentation.
  
  
  METHODS
  We retrospectively reviewed the records of patients with spina bifida who underwent bladder augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis.
  
  
  RESULTS
  Of 888 patients in our bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A total of 28 deaths (7.6%) occurred. The leading causes of mortality were nonurological infections (ventriculoperitoneal shunt related, decubitus ulcer fasciitis, etc) and pulmonary disease. Two patients (0.5%) died of renal failure. No patient died of malignancy or bladder perforation. Patients with a ventriculoperitoneal shunt had a higher mortality rate than those without a shunt (8.9% vs 1.5%, p = 0.04).
  
  
  CONCLUSIONS
  Previously reported mortality rates of 50% to 60% in patients with spina bifida do not appear to apply in children who have undergone bladder augmentation. On long-term followup leading causes of death in patients with spina bifida after bladder augmentation were nonurological infections rather than complications associated with augmentation or renal failure.
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana. Electronic address: szymanko@iupui.edu.
authors: Konrad M
authors: KM
authors: Szymanski
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Rosalia
authors: R
authors: Misseri
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Benjamin
authors: B
authors: Whittam
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Cyrus M
authors: CM
authors: Adams
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Jordan
authors: J
authors: Kirkegaard
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Shelly
authors: S
authors: King
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Martin
authors: M
authors: Kaefer
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Richard C
authors: RC
authors: Rink
authors: Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
authors: Mark P
authors: MP
authors: Cain
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications / Q000401:mortality*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D014547:Urinary Diversion; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult
keywords: mortality; spinal dysraphism; urinary bladder; urinary diversion; ventriculoperitoneal shunt