Achados clínicos e urodinâmicos em crianças e adolescentes com bexiga neurogênica refratária submetidos a cistoplastia de aumento

Abstract

Introduction: Neurological disorders, particularly neural tube defects such as spina bifida, can lead to neurogenic bladder (NB) in children and adolescents. NB is characterized by high-pressure filling of the bladder and inefficient emptying, resulting in complications such as urinary incontinence (UI), recurrent urinary infections, vesicoureteral reflux (VUR), and an increased risk of kidney damage. Initial treatments include clean intermittent catheterization, anticholinergic medications, or the application of botulinum toxin A. Augmentation cystoplasty (AC) is a surgical procedure aimed at creating a low-pressure, high-capacity bladder reservoir to preserve kidney function and improve quality of life. It is indicated when minimally invasive treatments fail. Ileocystoplasty and colocystoplasty are commonly used techniques to increase bladder capacity and compliance. Objectives: The primary objective of this study was to evaluate UI, VUR, and urodynamic parameters in children and adolescents with refractory NB after AC and compare these findings with preoperative data. The second objective was to conduct a systematic review to analyze the clinical and urodynamic findings in children and adolescents with NB who underwent AC. Patients and Methods: Retrospective cohort study that recruited 42 patients with refractory NB who underwent AC alone between February 2009 and March 2023. Exclusion criteria were patients with non-neurogenic lower urinary tract anomalies and patients with previous vesicostomy. The parameters evaluated in this study, before and after AC, with at least one year of follow-up, included UI, VUR and urodynamic data, such as maximum cystometric capacity (MCC), expected bladder capacity (EBC), bladder compliance and end filling detrusor pressure. Results: Of 22 eligible patients (50% male, median age 12 years- range from 7 to 19), 77.3% underwent ileocystoplasty with Mitrofanoff. Pre-AC, UI was diagnosed in 81.8% of patients, with 83.3% achieving complete resolution post-AC (p<0.001). VUR was present in 31.8% of patients’ pre-AC; post-AC, high-grade VUR resolved in 90.9 to 100% of the patients (p=0.001). Median MCC increased from 120 ml to 405 ml (p<0.001), and EBC normalized in 85.7% of patients (18/21) (p<0.001). Bladder compliance significantly improved from 6.4 ml/cmH2O to 38.3 ml/cmH2O (p<0.001), while median end filling detrusor pressure. decreased from 20.0 to 11.0 cmH2O (p<0.001). Conclusion: After AC, children and adolescents with refractory NB showed significant improvement in UI, VUR, MCC, bladder compliance and end filling detrusor pressure.