Journal of pediatric urology · 2026
Characteristics and follow-up results of bladder augmentation surgery at a pediatric center in South America.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Sager Cristian, Burek Carol, Gomez Yesica Ruth, Ruiz Javier, Imizcoz Felicitas Lopez, Rosiere Nicolas, Blain Otilia, Alberti Danel, Asen Leandro, Arenas Ignacio, Imaz Francisco, Tessi Catalina, Weller Santiago
Аннотация
BACKGROUND: Augmentation cystoplasty (AC) remains the standard reconstructive option for children with refractory lower urinary tract dysfunction (LUTD) and high-risk urodynamic patterns threatening renal function. However, postoperative morbidity and long-term renal outcomes remain clinically relevant concerns.
OBJECTIVE: To characterize postoperative complications following AC, evaluate functional and renal outcomes, and identify risk factors associated with intermediate and late adverse events.
STUDY DESIGN: Retrospective cohort study including patients ≤18 years with neurogenic or congenital bladder dysfunction refractory to optimized medical and endoscopic therapy, who underwent AC between 2003 and 2017 at a tertiary pediatric center. Minimum follow-up was 12 months. Pre- and postoperative assessment included standardized urodynamics, renal ultrasound, DMSA scintigraphy, and estimated glomerular filtration rate (eGFR). Complications were categorized by timing (early <30 days; intermediate 1-12 months; late >12 months) and by type (surgical or clinical). Kaplan-Meier analysis was performed for lithiasis-free survival.
RESULTS: A total of 128 patients (mean age 11 years) were included; myelomeningocele and anorectal malformations were the predominant etiologies. Preoperatively, approximately 50% presented with urinary incontinence, recurrent urinary tract infections (UTIs), hydronephrosis, and elevated detrusor leak point pressure (>40 cmH2O). Sigmoid colon was used in 78% of augmentations. At one year, mean maximum cystometric capacity increased by 142%, and mean end-detrusor pressure decreased to 23 cmH2O. Early surgical complications occurred in 12.5% of cases. During follow-up, UTIs were the most frequent clinical event. Bladder lithiasis developed in 20%, with a cumulative incidence of 20% at 70 months, and was significantly associated with constipation, irregular bladder irrigation, wheelchair dependence, and recurrent UTIs. At five years, renal function remained stable in 70.7%, improved in 11.1%, and worsened in 18.2%, without significant overall decline.
DISCUSSION: Despite functional improvements post-AC, intermediate-term postoperative morbidity remains considerable and is influenced by modifiable clinical factors. Interpretation of long-term renal and metabolic outcomes is limited by the retrospective design and heterogeneous follow-up duration.
CONCLUSION: Augmentation cystoplasty provides substantial and sustained improvements in bladder dynamics in children with severe LUTD. Nevertheless, intermediate-term morbidity-particularly UTIs and bladder lithiasis-remains frequent and is strongly influenced by modifiable postoperative management factors. Structured long-term follow-up focused on adherence to catheterization and irrigation protocols is essential to optimize urinary tract preservation.
OBJECTIVE: To characterize postoperative complications following AC, evaluate functional and renal outcomes, and identify risk factors associated with intermediate and late adverse events.
STUDY DESIGN: Retrospective cohort study including patients ≤18 years with neurogenic or congenital bladder dysfunction refractory to optimized medical and endoscopic therapy, who underwent AC between 2003 and 2017 at a tertiary pediatric center. Minimum follow-up was 12 months. Pre- and postoperative assessment included standardized urodynamics, renal ultrasound, DMSA scintigraphy, and estimated glomerular filtration rate (eGFR). Complications were categorized by timing (early <30 days; intermediate 1-12 months; late >12 months) and by type (surgical or clinical). Kaplan-Meier analysis was performed for lithiasis-free survival.
RESULTS: A total of 128 patients (mean age 11 years) were included; myelomeningocele and anorectal malformations were the predominant etiologies. Preoperatively, approximately 50% presented with urinary incontinence, recurrent urinary tract infections (UTIs), hydronephrosis, and elevated detrusor leak point pressure (>40 cmH2O). Sigmoid colon was used in 78% of augmentations. At one year, mean maximum cystometric capacity increased by 142%, and mean end-detrusor pressure decreased to 23 cmH2O. Early surgical complications occurred in 12.5% of cases. During follow-up, UTIs were the most frequent clinical event. Bladder lithiasis developed in 20%, with a cumulative incidence of 20% at 70 months, and was significantly associated with constipation, irregular bladder irrigation, wheelchair dependence, and recurrent UTIs. At five years, renal function remained stable in 70.7%, improved in 11.1%, and worsened in 18.2%, without significant overall decline.
DISCUSSION: Despite functional improvements post-AC, intermediate-term postoperative morbidity remains considerable and is influenced by modifiable clinical factors. Interpretation of long-term renal and metabolic outcomes is limited by the retrospective design and heterogeneous follow-up duration.
CONCLUSION: Augmentation cystoplasty provides substantial and sustained improvements in bladder dynamics in children with severe LUTD. Nevertheless, intermediate-term morbidity-particularly UTIs and bladder lithiasis-remains frequent and is strongly influenced by modifiable postoperative management factors. Structured long-term follow-up focused on adherence to catheterization and irrigation protocols is essential to optimize urinary tract preservation.