Factors Predicting Renal Function Outcome after Augmentation Cystoplasty

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Augmentation cystoplasty (AC) is a surgical procedure to increase bladder capacity.
• Refractory bladder dysfunction necessitates bladder augmentation, often with ileocystoplasty.
• Assessing long-term renal function after AC is crucial for patient management.

Purpose of the Study:

• To determine the causes of renal deterioration in adult patients following augmentation cystoplasty.
• To identify risk factors associated with declining estimated glomerular filtration rate (eGFR) post-AC.
• To evaluate the overall impact of AC on renal function.

Main Methods:

• Retrospective review of 29 adult patients who underwent ileocystoplasty for refractory bladder dysfunction (2004-2015).
• Analysis of changes in estimated glomerular filtration rate (eGFR) before and after surgery.
• Multivariate analysis to identify significant predictors of renal function decline.

Main Results:

• Significant improvements in bladder capacity, end-filling pressure, and compliance were observed post-AC.
• Renal function remained stable or improved in 76% of patients (median eGFR change: +7.84 ml/min/1.73 m²).
• Seven patients (24%) experienced significant renal deterioration, primarily linked to noncompliance with self-catheterization and recurrent pyelonephritis.

Conclusions:

• Augmentation cystoplasty itself does not cause progression to end-stage renal disease in patients with pre-existing renal insufficiency.
• Patient noncompliance with self-catheterization and recurrent pyelonephritis are significant risk factors for renal deterioration after AC.
• Close monitoring and adherence to post-operative care are essential for preserving renal function in AC patients.