title: Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux.
abstract: The objective of this study was to assess the clinical outcome of vesicoureteral reflux (VUR) after augmentation cystoplasty alone in patients with a hypocompliant neurogenic bladder. Between January 2009 and December 2014, 29 patients with a hypocompliant bladder associated with VUR confirmed by videourodynamics (VUD) preoperatively were recruited in this study. All patients had undergone bladder augmentation with a generous detubularized segment of bowel at our institution. No effort had been made to correct the existing reflux. Preoperative assessment included urinalysis, kidney function tests, ultrasonography, and videourodynamic evaluation. All patients had various degrees of VUR. The status of VUR and bladder function were studied by VUD. The mean follow-up period was 2.2 years (range 0.5-5.5 years). The VUD manifested a significant improvement of bladder capacity, diminution of intravesical pressure, and resolution of reflux after bladder augmentation. After the surgery, 24/29 (83%) no longer had reflux, 3/29 (10%) showed improvement in reflux, and 2/29 (7%) demonstrated no change in reflux. In addition, 16/21 (76%) patients had reflux Grades I-III; 100% patients with reflux Grades IV and V had complete cessation of reflux. Only one patient had symptomatic urinary infection after the surgery. Augmentation enterocystoplasty without ureteral reimplantation is thus effective and adequate for patients with high-pressure and hypocompliant neurogenic bladder. Therefore, ureteral reimplantation is not necessary when augmentation enterocystoplasty is recommended for patients with high-pressure, low-compliant bladder and VUR.
authors.affiliation: Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, PR China. Electronic address: zhcandjay@126.com.
authors.forename: Han-Chao
authors.initials: HC
authors.lastname: Zhang
authors.affiliation: Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, PR China.
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, PR China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, PR China.
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D003187:Compliance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation; D001750:Urinary Bladder, Neurogenic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Augmentation enterocystoplasty; Low-compliant bladder; Neurogenic bladder; Ureteral reimplantation; Vesicoureteral reflux