607 IS A BLADDER NECK SLING SAFE AND SUFFICIENT FOR ALL MYELOMENINGOCELE PATIENTS: WHO, IF ANY, WILL REQUIRE A BLADDER AUGMENTATION?

Abstract

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis1 Apr 2012607 IS A BLADDER NECK SLING SAFE AND SUFFICIENT FOR ALL MYELOMENINGOCELE PATIENTS: WHO, IF ANY, WILL REQUIRE A BLADDER AUGMENTATION? Blake Palmer, Yan Xiong, Jake Klein, Dominic Frimberger, and Bradley Kropp Blake PalmerBlake Palmer Oklahoma City, OK More articles by this author , Yan XiongYan Xiong Oklahoma City, OK More articles by this author , Jake KleinJake Klein Oklahoma City, OK More articles by this author , Dominic FrimbergerDominic Frimberger Oklahoma City, OK More articles by this author , and Bradley KroppBradley Kropp Oklahoma City, OK More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.684AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES More and more reports describe managing myelomeningocele neurogenic bladder (NGB) patients with an outlet procedure (bladder neck sling or bladder neck repair and sling) without bladder augmentation for patients with smaller than age expected bladder capacities. Historically, this was commonly unsuccessful and an unpredictable management strategy when artificial urinary sphincters were utilized as the outlet procedure. Our intent was to determine in our clinical practice if this was safe and in whom it could be predicted to be a sufficient management strategy. METHODS A retrospectively reviewed a database for all neurogenic bladder patients who underwent lower urinary tract reconstruction between 1997 and 2008 at the Children's Hospital of Oklahoma. We identified 2 cohorts of patients who underwent bladder neck sling alone and another who had a sling at the time of bladder augmentation. Preoperative urodynamic (UDS), postoperative UDS, bladder management, upper tract surveillance, surgical procedures, complications and long term continence outcomes were assessed for each group. RESULTS Group A has 6 patients who initially underwent bladder neck sling procedure only and Group B has 6 patients who had sling and concurrent bladder augmentation. In group A, 4 out of 6 patients bladder compliance deteriorated during postoperative follow-up and subsequently proceeded with bladder augmentation procedures because of decreased bladder capacity, increased detrusor leak point pressure (DLPP 40 cm H20), new and/or worsening hydronephrosis and persistent urinary incontinence. The dry rate (no leak for 4 hours with CIC) for Group A is 16.7% after initial sling procedures and 66.7% after 4 patients received bladder augmentation. CONCLUSIONS Although, the size of this study is small, numerical difference of preoperative UDS results and postoperative dry rate were clearly observed between groups. Patients with lower initial bladder capacity tended to have a higher chance to have bladder deterioration after sling procedure alone. However, after the subsequent augmentation these patients could still achieve similar dry rate as patient received concurrent augmentation. Bladder outlet management alone has the potential for deterioration of bladder dynamics and may require subsequent bladder augmentation. Close follow up is important if this management strategy is employed. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e247 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blake Palmer Oklahoma City, OK More articles by this author Yan Xiong Oklahoma City, OK More articles by this author Jake Klein Oklahoma City, OK More articles by this author Dominic Frimberger Oklahoma City, OK More articles by this author Bradley Kropp Oklahoma City, OK More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...