Long-term fate of the bladder after isolated bladder neck procedure

Benjamin Whittam, Konrad Szymanski, Rosalie Misseri, Aaron Carroll, Martin Kaefer, Richard Rink, Mark Cain

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: Recent and historical studies suggest that bladder neck procedures (BNPs) without augmentation are safe and effective. In select patients we have performed BNPs without concomitant augmentation. We sought to determine long-term outcomes of this approach and attempt to identify risk factors for bladder deterioration. Patients and methods: A retrospective chart review was conducted to identify patients who underwent a BNP without bladder augmentation and followed for at least 4 years. BNPs were only performed in patients with favorable preoperative urodynamics (UDS). The charts were analyzed for long-term outcomes with the primary endpoint of bladder augmentation. Results: Twenty-nine patients (21 females) with poor bladder outlet resistance underwent a BNP without augmentation (mean follow-up 8 years). Thirteen patients (45%) were augmented at an average of 2.6 years. No predictive UDS parameters were identified; however, exploratory analysis suggested detrusor pressure at 100 mL bladder volume prior to BNP (p = 0.009) was predictive of delayed augmentation. Conclusion: We report a 45% augmentation rate after isolated BNP in patients with favorable preoperative UDS parameters. We recommend close observation of this patient population with serial UDS, routine ultrasounds, and appropriate preoperative counseling prior to undertaking this approach, as this represents a life-long risk to the upper tracts.

Original languageEnglish
Pages (from-to)886-891
Number of pages6
JournalJournal of Pediatric Urology
Volume10
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Urinary Bladder
Urodynamics
Neck
Counseling
Observation
Pressure

Keywords

  • Bladder augmentation
  • Bladder neck procedure
  • Bladder neck repair

ASJC Scopus subject areas

  • Urology
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Long-term fate of the bladder after isolated bladder neck procedure. / Whittam, Benjamin; Szymanski, Konrad; Misseri, Rosalie; Carroll, Aaron; Kaefer, Martin; Rink, Richard; Cain, Mark.

In: Journal of Pediatric Urology, Vol. 10, No. 5, 2014, p. 886-891.

Research output: Contribution to journalArticle

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AU - Szymanski, Konrad

AU - Misseri, Rosalie

AU - Carroll, Aaron

AU - Kaefer, Martin

AU - Rink, Richard

AU - Cain, Mark

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AB - Objective: Recent and historical studies suggest that bladder neck procedures (BNPs) without augmentation are safe and effective. In select patients we have performed BNPs without concomitant augmentation. We sought to determine long-term outcomes of this approach and attempt to identify risk factors for bladder deterioration. Patients and methods: A retrospective chart review was conducted to identify patients who underwent a BNP without bladder augmentation and followed for at least 4 years. BNPs were only performed in patients with favorable preoperative urodynamics (UDS). The charts were analyzed for long-term outcomes with the primary endpoint of bladder augmentation. Results: Twenty-nine patients (21 females) with poor bladder outlet resistance underwent a BNP without augmentation (mean follow-up 8 years). Thirteen patients (45%) were augmented at an average of 2.6 years. No predictive UDS parameters were identified; however, exploratory analysis suggested detrusor pressure at 100 mL bladder volume prior to BNP (p = 0.009) was predictive of delayed augmentation. Conclusion: We report a 45% augmentation rate after isolated BNP in patients with favorable preoperative UDS parameters. We recommend close observation of this patient population with serial UDS, routine ultrasounds, and appropriate preoperative counseling prior to undertaking this approach, as this represents a life-long risk to the upper tracts.

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