Vesicouretral reflux with neuropathic bladder: studying the resolution rate after ileocystoplasty

To study vesicoureteral reflux (VUR) resolution and risk of pyelonephritis after augmentation ileocystoplasty in a cohort of patients with noncompliant neuropathic bladder.

We reviewed data for all children who underwent augmentation ileocystoplasty for noncompliant neuropathic bladder with associated VUR between July 2002 and July 2009. All patients were kept on oral antibiotic prophylaxis. Patients were followed up with renal/bladder ultrasound and voiding cystourethrography at 3 months postoperatively and annually thereafter.

A total of 52 patients with mean age 8.7 years (range 4-17 years) were identified. VUR was unilateral in 21 patients (40%) and bilateral in 31 patients (60%). VUR was low-grade (1-3) in 20 patients (38.5%) and high-grade (4-5) in 32 patients (61.5%). Mean follow-up duration was 27 months (range 12-80 months). VUR resolved in 35 of 52 patients (67%). Low-grade VUR resolved in 18 of 20 patients (90%), whereas high-grade reflux resolved in 17 of 32 patients (53%). This difference is statistically significant (P = .006). Although no patient with initial low-grade VUR developed pyelonephritis during follow-up, 8 of 32 patients (25%) with initial high-grade VUR developed pyelonephritis. Only 1 of 17 patients (6%) with resolved high-grade VUR developed pyelonephritis vs 7 of 15 patients (47%) with persistent high-grade VUR. Again the difference is statistically significant (P = .008).

Bilateral high-grade VUR in patients with neuropathic bladder persist after bladder augmentation in nearly half of patients. Half of those develop pyelonephritis during follow-up. Therefore, at the time of bladder augmentation for noncompliant neuropathic bladder, concomitant antireflux surgery should be performed for all patients with bilateral high-grade VUR.