Mortality after bladder augmentation in children with spina bifida

Area of Science:

• Pediatric Urology
• Spina Bifida Management
• Surgical Outcomes

Background:

• Renal failure is a primary cause of mortality in children with spina bifida.
• Bladder augmentation is a modern intervention to preserve renal function.
• Data on long-term mortality after bladder augmentation for spina bifida are limited.

Purpose of the Study:

• To determine long-term mortality rates in patients with spina bifida treated with bladder augmentation.
• To identify the primary causes of death in this patient population.

Main Methods:

• Retrospective review of 369 spina bifida patients who underwent bladder augmentation (1979-2013).
• Exclusion of patients born before 1972 or older than 21 years at augmentation.
• Data collection included demographics, surgical details, and outcomes from medical records and death indices.
• Statistical analysis using Fisher exact, Wilcoxon rank-sum tests, and Kaplan-Meier plots.

Main Results:

• Median follow-up was 10.8 years, with 28 deaths (7.6%) observed.
• Leading causes of mortality were nonurological infections (e.g., shunt-related, fasciitis) and pulmonary disease.
• Only 0.5% of deaths were attributed to renal failure; no deaths from malignancy or bladder perforation.
• Patients with a ventriculoperitoneal shunt had a significantly higher mortality rate (8.9% vs. 1.5%, p=0.04).

Conclusions:

• Mortality rates previously reported for spina bifida (50-60%) do not apply to patients who have undergone bladder augmentation.
• Long-term follow-up indicates nonurological infections are the main cause of death, not augmentation complications or renal failure.
• Bladder augmentation appears to be a safe and effective intervention for preserving renal function and improving survival in spina bifida patients.