Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux

Abstract

Objective To assess the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder. Methods Between January 2008 and January 2014, a total of 25 patients, with a hypocompliant bladder associated with vesicoureteral reflux confirmed by video-urodynamics preoperatively, were recruited in this study. They all had undergone bladder augmentation with a generous detubularized segment of bowel at our institution. No effort had been made to correct existing reflux. Preoperatively assessment included urinalysis, kidney function tests, ultrasonography, video-urodynamic evaluation. All patients had various degrees of vesicoureteral reflux. The status of vesicoureteral reflux and bladder function were studied by video-urodynamic. Results Mean follow-up was 2.2 years (range 0.5 to 5.5 years). The video-urodynamics manifested a significant improvement of bladder capacity, diminution of intravesical pressure and resolution of reflux after bladder augmentation. Of the 25 patients, 20 (80%) no longer had reflux, 3 (12%) had improvement, 2 (8%) had no change. Sixteen of 18 with grades Ⅰ to Ⅲ (89%), all refluxing units with grade Ⅳ to grade Ⅴ (100%) showed complete cessation of reflux. Symptomatic urinary infection was not found after surgery. Conclusions Augmentation enterocystoplasty without ureteral reimplantation is effective and adequate for patients with high pressure and hypocompliant neurogenic bladder. Therefore, ureteral reimplantation is not necessary underwent when augmentation enterocystoplasty is recommended to patients with neurogenic bladder and vesicoureteral reflux. Key words: Urinary bladder, neurogenic; Vesico-ureteral reflux; Augmentation enterocystoplasty; Ureteral reimplantation