Do we have to do ureteric reimplantation during augmentation cystoplasty in patients with spastic neurogenic bladder?

Abstract

Introduction: If medical treatment and/or interventional methods have failed, and high intravesical pressure and urinary incontinence or recurring urinary tract infections persist combined with present vesicoureteral reflux and impaired renal function, surgical treatment in terms of bladder augmentation is indicated.

Aim of the study: The main objective of this study was to evaluate whether we have to do ureteral reimplantation in patients with spastic neurogenic bladder during augmentation.

Patients and methods: A total of 72 patients with spastic neurogenic bladder with VUR were included in the study. The median age at surgery was 12 years, ranging from 3 to 27 years. All of them underwent augmentation cystoplasty for the period between 2016 and 2023. The changes in VUR grade and urodynamic findings were retrospectively evaluated.

Results: The median follow-up after AC surgery was 1.5 years, ranging from 0.3 to 2.3 years. The changes in vesicoureteral reflux (VUR) grade before and after surgery: VUR was detected in 72 patients, involving 89 ureters. Among the 89 ureters, the reflux grade was V in 31, IV in 34, III in 23, I in 11. Postoperative VCUG revealed that the reflux resolved in 74 ureters (83%) and was downgraded in 15 ureters (17%). During urodynamics, it was observed that the bladder capacity at which VUR occurred significantly increased from 50 to 450 mL (p < 0.05). However, there was no significant change in detrusor pressure at the onset of VUR.

Conclusion: In patients with spastic neurogenic bladder undergoes augmentation cystoplasty: Routine ureteral reimplantation may not be necessary.