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Updated: Apr 26, 2026
Evaluation of Biomaterials for Bladder Augmentation using Cystometric Analyses in Various Rodent Models
Published on: August 9, 2012
Mortality after bladder augmentation in children with spina bifida
Konrad M Szymanski1, Rosalia Misseri1, Benjamin Whittam1
1Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
Insights
Long-term survival for spina bifida patients undergoing bladder augmentation is improved. Leading causes of death are nonurological infections, not renal failure or augmentation complications.
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.
Purpose:
Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with bladder augmentation.
Materials And Methods:
We retrospectively reviewed the records of patients with spina bifida who underwent bladder augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis.
Results:
Of 888 patients in our bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A total of 28 deaths (7.6%) occurred. The leading causes of mortality were nonurological infections (ventriculoperitoneal shunt related, decubitus ulcer fasciitis, etc) and pulmonary disease. Two patients (0.5%) died of renal failure. No patient died of malignancy or bladder perforation. Patients with a ventriculoperitoneal shunt had a higher mortality rate than those without a shunt (8.9% vs 1.5%, p = 0.04).
Conclusions:
Previously reported mortality rates of 50% to 60% in patients with spina bifida do not appear to apply in children who have undergone bladder augmentation. On long-term followup leading causes of death in patients with spina bifida after bladder augmentation were nonurological infections rather than complications associated with augmentation or renal failure.
