Long-term outcome in bladder detrusorectomy augmentation

Background and Objectives: Bladder augmentation in children can have significant benefits in terms of continence and social function. In an attempt to overcome the problems associated with using foreign mucosa in the urinary tract, techniques to increase to bladder volume and improve compliance by resecting the detrusor muscle alone have been described. Here we describe our experience using an omental-backed detrusorectomy augmentation and examine possible reasons for a poor outcome observed in some patients in the longer term. Methods: This was a retrospective review covering an eight-year period with a minimum follow-up of 2 years. Pre- and post-operative urodynamics were performed in every case. Results: 11 patients were included in the study. There were 7 male and 4 female patients with a median age of 10 years (range 4-16). The underlying pathology in 6 patients was myelodysplasia and in the remaining cases there was one each of ano-rectal malformation with neuropathic bladder, Guillain-Barre syndrome, a myopathy of unknown cause, transverse myelitis and one case of a non-neuropathic neuropathic bladder. Detrusorectomy provided a modest increase in bladder capacity (median 26%) and decrease in maximum bladder pressure (median 12%). Long-term follow-up has revealed treatment failure in 6 patients, resulting in revision augmentation surgery in 3 (with surgery planned in a further 2), and one patient developing end-stage renal failure. Notable complications were bladder stone formation in 4 patients and troublesome lower abdominal pain related to bladder drainage in 2. There appeared to be no correlation between initial diagnosis, age at operation, pre-operative urodynamics, peri- or post-operative factors, and long-term outcome. Conclusion: In our series, omental-backed detrusorectomy for a neuropathic bladder in children resulted in a poor outcome in 55% of cases. We were unable to identify factors that would allow this result to be predicted pre-operatively.