Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review.
OBJECTIVE
To systematically evaluate effectiveness and safety of bladder augmentation for adult neuro-urological patients.


METHODS
The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement was followed for review of publications. The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched until January 2015. No limitations were placed on date or language. Non-original articles, conference abstracts, and publications involving children and animals were excluded. Risk-of-bias and confounder assessment was performed.


RESULTS
A total of 20 studies including 511 patients were eligible for inclusion. The level of evidence for the included studies was low, most level 4 studies with only one level 3 study. The data were narratively synthesized. Across all studies high risk-of bias and confounding was found. Primary outcomes were assessed in 16 of the 20 studies and showed improved quality of life and anatomical changes as well as stable renal function. The secondary outcomes were reported in 17 of the 20 studies and urodynamic parameters and continence all demonstrated improvement after bladder reconstruction. Long-term complications continued up to 10 years post-operatively, including bowel dysfunction in 15% of the patients, stone formation in 10%, five bladder perforations and one bladder cancer.


CONCLUSIONS
Available studies are not plentiful and of relatively poor quality, appropriately designed prospective studies are urgently needed. Despite this, bladder augmentation appears to be a highly effective procedure at protecting the upper urinary tract and improving quality of life. However, it is associated with relatively high morbidity in both the short and long term.
Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
Lisette 't
L'
Hoen
Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom.
Hazel
H
Ecclestone
Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
Bertil F M
BFM
Blok
Department of Urology, Aix Marseille University, Marseille, France.
Gilles
G
Karsenty
Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.|Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
Véronique
V
Phé
Department of Urology, Aix Marseille University, Marseille, France.
Romain
R
Bossier
Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
Jan
J
Groen
Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.|Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
David
D
Castro-Diaz
Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.|Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
Bárbara
B
Padilla Fernández
Department of Neuro-Urology, Careggi University Hospital, Florence, Italy.
Giulio
G
Del Popolo
Department of Neuro-Urology, Careggi University Hospital, Florence, Italy.
Stefania
S
Musco
Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
Jürgen
J
Pannek
Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Thomas M
TM
Kessler
Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
Tobias
T
Gross
Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Marc P
MP
Schneider
Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom.
Rizwan
R
Hamid
D006801:Humans; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology*; D013520:Urologic Surgical Procedures
bladder augmentation; bladder dysfunction; bowel segment; neurogenic patients; systematic review