Upper tract changes in patients with neurogenic bladder and sustained pressures >40 cm following bladder neck surgery without augmentation

Warren Snodgrass, Carlos Villaneuva, Micah Jacobs, Patricio Gargollo

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective We report new hydronephrosis or VUR (vesicoureteral reflux) in patients with end filling pressures >40 cm for at least 1 year after bladder neck surgery without augmentation for neurogenic incontinence.

Materials Consecutive children with neurogenic sphincteric incompetency had bladder neck surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually. Those with sustained end fill pressures >40 cm for ≥1 year were included as participants in the study.

Results Of 79 patients, 17 (22%) had end fill pressures >40 cm for at least 1 year despite anticholinergics, with follow-up a mean of 39 months. New hydronephrosis or VUR developed in six (35%). All new hydronephrosis resolved with medical treatment, as did two out of three new VUR cases. The other patient with VUR had successful Dx/HA (dextranomer hyaluronic acid) injection.

Conclusions Despite sustained pressures >40 cm, upper tract changes developed in only 35% of patients, and resolved with medical management or minimally invasive interventions. End pressures should not be used as an independent indication for augmentation.

Original languageEnglish (US)
Pages (from-to)744-748
Number of pages5
JournalJournal of Pediatric Urology
Volume10
Issue number4
DOIs
StatePublished - Aug 1 2014

Keywords

  • Bladder neck sling
  • Bladder neck surgery
  • Detrusor leak point pressure
  • Neurogenic bladder

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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