Long-term outcomes of the neobladder in pediatric continent urinary reconstruction

In rare instances when native bladder tissue is either unsuitable or unavailable a continent neobladder may be an option for pediatric lower urinary tract reconstruction. We report our long-term outcomes and experience in this challenging patient population.

A retrospective cohort study was performed of all patients who underwent creation of a neobladder at 2 pediatric institutions. Patient demographics, surgical details and clinical outcomes were abstracted from the medical records.

A total of 26 patients were identified with a median age of 8.9 years at surgery. Median followup was 8.0 years. Most procedures used a composite of gastric and ileal tissue. All patients were continent of urine and had a stable upper urinary tract. Median bladder capacity was 400 ml. Postoperative complications included reservoir stones (8 patients), febrile urinary tract infection (8), metabolic acidosis (6), small bowel obstruction (4), bladder perforation (4) and pelvic lymphocele (1). Five patients had difficulty with catheterization due to stomal stenosis. Gross hematuria with clots developed in 1 patient with anuria who had a gastroileal neobladder and was awaiting renal transplantation. No other patient with a gastric component had the hematuria-dysuria syndrome. Five patients had end stage renal disease and subsequently underwent successful renal transplantation. No upper urinary tract deterioration was observed, and no malignant transformation has occurred.

Creation of a continent neobladder is a reconstruction option in children when bladder augmentation is not feasible. However, complication rates are not insignificant, underscoring the need for careful long-term followup.