Effectiveness and Complications of Augmentation Cystoplasty with or without Nonrefluxing Ureteral Reimplantation in Patients with Bladder Dysfunction: A Single Center 11-Year Experience

Abstract

Purpose: We reviewed our experience with the effectiveness and complications of augmentation cystoplasty with or without nonrefluxing ureteral reimplantation in adult patients with long-standing bladder dysfunction.

Materials and methods: We retrospectively reviewed the records of 173 patients who underwent augmentation cystoplasty with or without ureteral reimplantation at our center from July 2005 to July 2016. Clinical data, and magnetic resonance urography and videourodynamic parameters were collected. Upper urinary tract dilatation and vesicoureteral reflux grading systems were used to evaluate upper urinary tract function. Postoperative complications were evaluated.

Results: Ureteral reimplantation was performed in 160 patients (266 ureteral units) and 120 ureteral units were simultaneously managed by tailoring and/or ureterolysis. Mean followup was 44.4 months (range 3 to 108). Mean maximum bladder capacity and bladder compliance significantly increased (p <0.0001), and maximum detrusor pressure and serum creatinine decreased compared with preoperative levels (p <0.05). Upper urinary tract dilatation and vesicoureteral reflux significantly improved after surgery. Postoperative complications included persistent vesicoureteral reflux in 1 patient (0.6%), anastomotic stricture in 14 ureteral units (5.3%), bowel dysfunction in 11 patients (6.4%), a need for laparotomy in 4 (2.3%), urinary tract stone in 15 (8.7%) and deteriorating renal function in 9 (5.2%).

Conclusions: This retrospective study indicates that ureteral reimplantation concomitant with augmentation cystoplasty may be beneficial in patients with low pressure or high grade vesicoureteral reflux, ureterovesical junction obstruction or ureteral tortuosity, and adhesions and/or severe upper urinary tract dilatation, especially in those with a long medical history.

Keywords: kidney; postoperative complications; replantation; ureter; urinary bladder.