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Bladder augmentation is utilised to treat children with neuropathic bladders secondary to spina bifida that results in hostile urodynamics, renal deterioration and / or urinary incontinence. Whilst it is associated with an improved quality of life and low mortality, it is important to understand the long-term risks of undergoing such surgery. Szymanski et al. (Indianapolis) have thus reviewed a cohort of spina bifida patients born after 1972 and followed at their institution after augmentation performed between 1979 and 2018. A total of 413 patients were included. Median age at augmentation was 8.5 years. Overall, 182 (44.1%) underwent 370 additional surgeries. Bladder stone surgery was the most common complication (57.6%), followed by repair of bladder perforation (17%). Bladder stones were the most common recurrent complication. The highest risk of subsequent surgeries was within the first five years after augmentation. The 10-year risk of urinary diversion was 2.7%. Detubularisation and reconfiguration of the augmentation segment reduced the risk of bladder perforation, its recurrence or requiring re-augmentation. They also looked at a subset (‘modern cohort’) of 222 patients undergoing augmentation with a detubularised and reconfigured bowel segment after the year 2000. The study provides an extensive and comprehensive review of complications following bladder augmentation and will aid preoperative discussion with patients and their parents / carers allowing provision of accurate data from the modern era. I can recommend this publication for both paediatric urologists and their adult counterparts who will look after these patients following transition.

Additional surgeries after bladder augmentation in patients with spina bifida in the 21st Century.
Szymanski KM, Misseri R, Whittam B, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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