Do We need ureteric re-implantation during augmentation cystoplasty? a videourodinamic evaluation

Abstract

Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children with high pressure low compliant bladders and vesicoureteral reflux (VUR) who underwent augmentation cystoplasty without antireflux surgery. We hypothesized that not always bad preoperative bladder dynamics are to blame for the associated VUR. VUR persists despite successful augmentation in some. We tried to find objective urodynamic criteria where antireflux surgery might potentially be necessary to avoid persisting VUR. Material and methods 19 meningomyelocele patients with hypocompliant overactive bladder and associated high gradeVUR with a mean age of 11.4 years(5-21) underwent ileocystoplasty alone. Bladder outlet procedures, previous operation and persitent night-time drainage were excluded. Bladders were assessed preoperatively and sixth months postoperatively by multicycleVUDs Results VUR persisted in 9 patients despite a low pressure, compliant bladder being achieved. In these, VUR started at lower volumes with a mean of 29.6ml;(19-52ml) and lower pressures with a mean of 14.6cm-H20(9.6-25). Whereas in patients with no persistent VUR, it started at higher pressures (mean 49 cm-H20)(33-68). When preoperative VUD findings were retrospectively analysed, VUR started at lower volumes (mean14.8ml; 8-33) and intravesical pressures (mean7.8 cm-H20; 4 -17) in these 9 patients when compared to cases with resolved VUR Conclusions Preoperative VUD findings might be a predictor for resolution of VUR after augmentation. If VUR starts at low pressures, it is very likely to persist after augmentation. In these patients VUR should be corrected during augmentation. Further urodynamic cut off values for reimplantation would be useful to predict the outcome and thus the approach to VUR during augmentation.