Response to commentary to ‘Upper tract changes in patients with neurogenic bladder and sustained pressures >40 cm following bladder neck surgery without augmentation’

Abstract

Our study was not designed to determine if bladder filling pressures >40 cm are an independent risk factor for renal scars or function loss. Rather, it was conceived a decade ago to determine if preoperative assessment could discern patients who would require augmentation after bladder neck surgery for neurogenic incontinence versus those who would not. Although other studies to that time found that preoperative urodynamics (UD) did not predict need for subsequent augmentation, selection bias for simultaneous augmentation and lack of agreed criteria indicating augmentation limited the strength of those observations. Commentary to ‘Upper tract changes in patients with neurogenic bladder and sustained pressures >40 cm following bladder neck surgery without augmentation’Journal of Pediatric UrologyVol. 10Issue 4PreviewI congratulate Snodgrass et al. [1] on their continued interest in carefully defining which pediatric patients might benefit from bladder augmentation, and in essence agree that end filling pressure (EFP) as an isolated factor should not dictate whether a patient should undergo bladder augmentation. In their article they challenge the longstanding concept that leak point pressure over 40 cm H20 may be detrimental to long-term renal function, which has historically been a major factor in mortality and morbidity in patients with spina bifida but has almost been eliminated in the modern era of bladder reconstruction and medical management (Misseri, R, Szymanski, K et al. Full-Text PDF Commentary to ‘Upper tract changes in patients with neurogenic bladder and sustained pressures >40 cm following bladder neck surgery without augmentation’Journal of Pediatric UrologyVol. 10Issue 4PreviewAlthough the study by Snodgrass et al. [1] is a brave attempt to take a different road in the management of neurogenic bladders, many doubts remain. Having been asked to write an editorial comment on this article is a difficult task, as one of the authors of this comment (TJ), as a reviewer, had strongly recommended the rejection of the manuscript. Full-Text PDF