The Concerns of Mechanical Upper Urinary Tract Obstruction in Neurogenic Lower Urinary Tract Dysfunction: Beyond Augmentation Cystoplasty

Overview

Journal Front Surg

Specialty General Surgery

Date 2023 Apr 10

PMID 37035566

Authors

Zhonghan Zhou

Xuesheng Wang

Limin Liao

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the efficacy of augmentation uretero-enterocystoplasty (AUEC), a modified surgical procedure that focuses the mobilization of the ureter and the necessity of ureteroplasty in a series of neurogenic lower urinary tract dysfunction (NLUTD) patients with mechanical upper urinary tract obstruction (mUUTO).

Methods: We retrospectively reviewed the medical records of NLUTD patients who underwent an AUEC from 2005 to 2022. mUUTO was diagnosed by preoperative bladder drainage, magnetic resonance urography (MRU), and isotope renography. Upper urinary tract dilatation (UUTD) was evaluated using MRU with the Liao MRU-UUTD system.

Results: A total of 58 patients and 103 ureters were analyzed. Improvement in maximum bladder capacity (from 79.0 [41.3-163.8] to 500.0 [450.0-597.5] ml, < 0.001), maximum detrusor pressure (from 32.0 [13.0-50.8] to 5.5 [4.0-10.0] cmHO, < 0.001) and bladder compliance (from 6.5 [3.0-11.9] to 50.1 [37.5-65.0] ml/cmHO, < 0.001), and stabilization of serum creatine (93.4 [73.0-142.7] to 94.9 [72.2-148.7] μmol/L, = 0.886) were observed. The proportion of high-grade UUTD was significantly reduced after the surgery (92.3% vs. 13.5%, 92.1% to 9.8%, < 0.001), and the typical imaging signs of preoperative obstruction disappeared.

Conclusion: Beyond traditional augmentation cystoplasty, more attention should be paid to the relief of mUUTO and mobilization of the ureter in NLUTD patients.

References

Liao L . Evaluation and Management of Neurogenic Bladder: What Is New in China?. Int J Mol Sci. 2015; 16(8):18580-600. PMC: 4581261. DOI: 10.3390/ijms160818580. View

Liao L, Zhang F, Chen G . Midterm outcomes of protection for upper urinary tract function by augmentation enterocystoplasty in patients with neurogenic bladder. Int Urol Nephrol. 2014; 46(11):2117-25. DOI: 10.1007/s11255-014-0782-2. View

FARMELANT M, BURROWS B . The renogram: physiologic basis and current clinical use. Semin Nucl Med. 1974; 4(1):61-73. DOI: 10.1016/s0001-2998(74)80024-3. View

Wang J, Liu C, Tsai S, Wei C, Chin T . Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder. J Chin Med Assoc. 2011; 74(7):294-7. DOI: 10.1016/j.jcma.2011.05.004. View

Liao L . A new comprehensive classification system for both lower and upper urinary tract dysfunction in patients with neurogenic bladder. Urol Int. 2014; 94(2):244-8. DOI: 10.1159/000365056. View

Liao L, Zhang F, Chen G . New grading system for upper urinary tract dilation using magnetic resonance urography in patients with neurogenic bladder. BMC Urol. 2014; 14:38. PMC: 4046082. DOI: 10.1186/1471-2490-14-38. View

Wilcox D, Mouriquand P . Management of megaureter in children. Eur Urol. 1998; 34(1):73-8. DOI: 10.1159/000019665. View

Ying X, Liao L . Augmentation uretero-enterocystoplasty for refractory urinary tract dysfunction: a long-term retrospective study. BMC Urol. 2021; 21(1):166. PMC: 8638541. DOI: 10.1186/s12894-021-00927-z. View

Cheng P, Myers J . Augmentation cystoplasty in the patient with neurogenic bladder. World J Urol. 2019; 38(12):3035-3046. DOI: 10.1007/s00345-019-02919-z. View

10.

Panicker J . Neurogenic Bladder: Epidemiology, Diagnosis, and Management. Semin Neurol. 2020; 40(5):569-579. PMC: 9715349. DOI: 10.1055/s-0040-1713876. View

11.

Taghavi K, OHagan L, Bortagaray J, Bouty A, Hutson J, OBrien M . Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20-year review. ANZ J Surg. 2021; 91(5):1005-1010. DOI: 10.1111/ans.16736. View

12.

DUCKETT J, Bellinger M . A plea for standardized grading of vesicoureteral reflux. Eur Urol. 1982; 8(2):74-7. DOI: 10.1159/000473484. View

13.

Khavari R, Fletcher S, Liu J, Boone T . A modification to augmentation cystoplasty with catheterizable stoma for neurogenic patients: technique and long-term results. Urology. 2012; 80(2):460-4. DOI: 10.1016/j.urology.2012.03.038. View

14.

Farrugia M, Whitaker R . The search for the definition, etiology, and effective diagnosis of upper urinary tract obstruction: the Whitaker test then and now. J Pediatr Urol. 2019; 15(1):18-26. DOI: 10.1016/j.jpurol.2018.11.011. View

15.

Soylet Y, Emir H, Ilce Z, Yesildag E, Buyukunal S, Danismend N . Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty. BJU Int. 2004; 94(3):379-80. DOI: 10.1111/j.1464-410X.2004.04965.x. View

16.

Reyblat P, Ginsberg D . Augmentation cystoplasty: what are the indications?. Curr Urol Rep. 2008; 9(6):452-8. DOI: 10.1007/s11934-008-0078-0. View

17.

Shokeir A, Nijman R . Primary megaureter: current trends in diagnosis and treatment. BJU Int. 2000; 86(7):861-8. DOI: 10.1046/j.1464-410x.2000.00922.x. View

18.

Reid S, Tophill P, Osman N, Hillary C . Augmentation cystoplasty in neuropathic bladder. J Spinal Cord Med. 2018; 43(2):217-222. PMC: 7054904. DOI: 10.1080/10790268.2018.1525974. View

19.

Cetinel B, Kocjancic E, Demirdag C . Augmentation cystoplasty in neurogenic bladder. Investig Clin Urol. 2016; 57(5):316-23. PMC: 5017553. DOI: 10.4111/icu.2016.57.5.316. View

20.

Cheng K, Kan C, Sau-Kwan Chu P, Man C, Wong B, Ho L . Augmentation cystoplasty: Urodynamic and metabolic outcomes at 10-year follow-up. Int J Urol. 2015; 22(12):1149-54. DOI: 10.1111/iju.12943. View