Augmentation of Non-Compliant Bladder with Associated Vesicouretral Reflux (VUR): is Concomitant Antireflux Surgery Mandatory?

Abstract

Purpose We studied VUR resolution and risk of pyelonephritis following bladder augmentation. Material and Methods Between February 2005 and March 2009, 42 patients underwent ileocystoplasty for non-compliant bladder at a mean age of 9 years (range 4-17). Patients included 29 boys and 13 girls. The indications are neuropathic bladder (NB) in 19, posterior urethral valves (PUV) in 12, and bladder exstrophy (BE) in 11. Bladder neck reconstruction was performed for 21 patients (50%). VUR was low-grade in 15 (34%), high-grade in 27 (64%), unilateral in 18 (43%), and bilateral in 24 (57%). All patients were kept on oral antibiotic prophylaxis. Patients were followed up with renal/bladder ultrasound and voiding cystourethrography at 3 months postoperatively and annually thereafter. Results Mean follow-up duration was 20 months (range 8-48). VUR resolved in 21 patients (50%). During follow-up 6 patients (14%) had documented one or more attacks of break-through pyelonephitis. For PUV patients, VUR resolution rate was 83% and pyelonephritis rate was 8%. For BE, VUR resolution rate was 18% and pyelonephritis rate was 9%. For NB, VUR resolution rate was 47% and pyelonephritis rate was 21%. For patients with initial low-grade VUR, resolution rate was 33% and rate of pyelonephritis was 0%. Although patients with initial high-grade VUR had higher resolution rate of 59%, the rate of pyelonephritis was 22% which is of statistical significance (p Conclusions At time of bladder augmentation, concomitant anti-reflux surgery should be performed for all patients with initial high grade VUR regardless of etiology. If left uncorrected, the risk of pyelonephritis and subsequent need for a difficult anti-reflux surgery is 22%.