Augmentation cystoplasty in children with neuropathic bladder: long-term outcomes after 30 years experience.

Background: Augmentation cystoplasty (AC) is a useful alternative for the treatment of neuropathic bladder, although there are few studies reporting long-term results. We assess our experience over the last 30-years.

Methods: A retrospective study was conducted in patients with neuropathic bladder in whom AC was performed in our institution between 1990-2020. Demographic variables, pre- and post- AC urodynamic studies, long-term outcomes and postoperative complications were collected.

Results: Eighty-six patients (43 males and 43 females) underwent AC surgery with a median age of 12.8 years (interquartile range 9.6-15.1). Bladder augmentation was performed with ileum in 49 cases (57%), sigma in 32 cases (37.2%) and ureter in 5 cases (5.8%). In 27 patients an artificial urinary sphincter (AUS) was placed at the same intervention. The mean preoperative bladder capacity was 117 mL (SD 40), which was increased to 430 mL (SD 64) one year after surgery, this difference being statistically significant (P<0.001). Median follow-up was 24.5 years (interquartile range 17.5-26). Vesico-ureteral reflux improved after AC in 78.9% with no other surgical interventions. Seven mechanical complications associated with AUS were reported. Bladder lithiasis was reported in 9 patients. No bladder perforations were described. One patient developed bladder squamous cell carcinoma 16 years after AC, requiring radical cystectomy and Hautmann neobladder.

Conclusions: Long-term results of this study demonstrate that AC is an effective surgical treatment in patients with neuropathic bladder patients without proper response to medical treatment. The risk of developing complications long after bladder augmentation makes close clinical follow-up of these patients essential.