Outcomes of seromuscular bladder augmentation compared with standard bladder augmentation in the treatment of children with neurogenic bladder

BACKGROUND Intestinal seromuscular bladder augmentation(SMBA)surgery has produced no mucosal-related complications,but its outcomes need to be studied.AIM To evaluate the safety and effectiveness of SMBA in the treatment of children with neurogenic bladder.METHODS A retrospective analysis of the clinical data of children with SMBA was performed from March 2008 to February 2018,and the data were compared with those of children receiving standard cystoplasty(SC).RESULTS In a cohort of 67 children who underwent bladder augmentation,the 46 children in the SC group had an average age of 10.6 years and a follow-up time of 36 mo,and the 21 children in the SMBA group had an average age of 7.6 years and a follow-up time of 29.7 mo.The preoperative and postoperative bladder volumes in the SMBA group were 151.7 mL and 200.4 mL,respectively,and those in the SC group were 173.9 mL and 387.0 mL,respectively.No significant difference in preoperative urinary dynamic parameters was found between the two groups,but the difference after operation was statistically significant.The main complications after SMBA were residual ureteral reflux and failed bladder augmentation,with incidences of 33.3%and 28.6%,respectively.In all 6 patients with failed augmentation in the SMBA group,ileum seromuscular patches were used for augmentation,and SC was chosen for reaugmentation.During reoperation,patch contracture and fibrosis were observed.CONCLUSION The improvement of urinary dynamic parameters in the SMBA group was significantly lower than that in the SC group.Children with SMBA had a higher probability of patch contracture and reaugmentation,which might be related to impaired blood supply and urine stimulation,and the sigmoid colon patch should be the priority.

Robot-assisted ileocystoplasty for the treatment of adult neurogenic bladder: A video demonstration and outcomes

Ileocystoplasty is one of the treatment options in the armamentarium for the management of adults with neurogenic bladder dysfunction,after failure of less invasive treatment alternatives,such as intravesical onabotulinum toxin A injection therapy and sacral neuromodulation.It has traditionally been performed as open surgery and can be associated with significant morbidity,especially in the early postoperative period.[1]Complications associated with open ileocystoplasty include prolonged postoperative ileus,wound infections,and pain.Performing robot-assisted ileocystoplasty can reduce the morbidity associated with open surgery[2]and has been shown to be safe and feasible in experienced hands,[3]although it may be associated with increased operative duration because of its learning curve.Our technique of robot-assisted ileocystoplasty and early postoperative outcomes is demonstrated in this video(Supplemental Digital Content,https://links.lww.com/CURRUROL/A47).Robotic console time was 180 minutes,with minimal blood loss.Eight-hourly catheter aspiration and flushes were performed to manage the mucus in the urine.There were no metabolic acidosis or electrolyte derangements postoperatively.The patient was discharged on postoperative day 5.Postoperative cystogram at week 2 showed no leak and the patient is doing well at 1 year postoperatively.Robotic ileocystoplasty is safe and feasible and can reduce the morbidity associated with open surgery with good outcomes.