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Updated: May 28, 2025
Evaluation of Biomaterials for Bladder Augmentation using Cystometric Analyses in Various Rodent Models
Published on: August 9, 2012
Long-term outcomes of "clam" bladder augmentation in a pediatric population with neurogenic refractory bladder
Aurora Mariani1, Marc-David Leclair2, Sébastien Faraj2
1Service d'urologie et de chirurgie pédiatrique, CHU d'Angers, Angers, France; Clinique urologique, laboratoire d'urodynamique, Nantes université, Nantes, France.
Insights
Bladder augmentation (BA) using clam cystoplasty is a safe and effective treatment for children with neurological bladder, showing sustained improvements in bladder function and capacity over time. This procedure demonstrates favorable long-term outcomes with a low re-intervention rate and no cases of refractory detrusor overactivity.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urodynamics
Background:
- Bladder augmentation (BA) is crucial for managing pediatric neurogenic bladder and detrusor overactivity (DO).
- The bivalve cystoplasty (Clam) technique is preferred over supratrigonal cystectomy in pediatric populations.
- Evaluating long-term outcomes and re-intervention rates of Clam cystoplasty is essential for optimizing patient care.
Purpose of the Study:
- To assess the re-intervention rate and long-term outcomes of bladder augmentation (BA) via clam cystoplasty in children.
- To evaluate the incidence of refractory detrusor overactivity (DO) following clam cystoplasty during follow-up.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) undergoing clam cystoplasty for neurogenic bladder from 2004 to 2023.
- Pre- and postoperative urodynamic assessments were conducted to evaluate bladder function.
- Analysis included re-intervention rates, complication rates (Clavien >2), and long-term urodynamic parameters.
Main Results:
- Twenty-six pediatric patients (median age 8 years) with neurogenic bladder (spina bifida, Hinman syndrome, sacral agenesis) underwent clam cystoplasty using ileum.
- The overall re-intervention rate was 41% over a median follow-up of 7 years, with early and late complication rates of 11% and 22%, respectively.
- Significant postoperative improvements were observed in bladder compliance, detrusor overactivity (DO), and bladder capacity, with sustained effects up to 15 years. No refractory DO or need for a second augmentation was noted.
Conclusions:
- Bladder augmentation with clam cystoplasty is a safe and effective surgical option for pediatric neurogenic bladders.
- The procedure yields sustained improvements in urodynamic parameters, comparable to existing literature.
- Favorable long-term outcomes are indicated by the absence of refractory DO and the low requirement for additional augmentation procedures.
Purpose:
Bladder augmentation (BA) is the gold standard treatment to increase compliance and treat neurological detrusor overactivity (DO) in children with neurological bladder refractory to medical treatment. In pediatrics, bivalve cystoplasty (Clam) is preferred to supratrigonal cystectomy. Our initial aim was to evaluate the re-intervention rate and long-term outcomes of BA in relation to Clam in children. The secondary aim was the evaluation of refractory DO during follow-up after Clam cystoplasty.
Methods:
A retrospective analysis was performed including all patients<18years of age operated for BA with Clam for neurological bladder (01/2004 to 01/2023). Pre- and postoperative urodynamics were performed.
Results:
Twenty-six patients (14 girls and 12 boys) underwent surgery for BA. The median age was 8years (IQR: 5-12). The causes of Neurogenic Low Urinary Tract Dysfunction were spina bifida in 8 patients, Hinman syndrome in 8 patients and sacral agenesis in 8 patients. The ileum was used in 100% of cases and 8 children had continent catheterizable channels inserted (29.6%). The overall re-intervention rate was 41% (11/27) for median follow-up of 7years (IQR: 4-12). The rates of early and late complications>Clavien 2 were 11% and 22% respectively. BA resulted in significant postoperative improvements (at 1, 5, 10 and 15years) in compliance (P=0.0332), detrusor overactivity (DO) (P=0.032) and bladder capacity [167mL preoperatively and 425mL at 15years (P<0.0001)]. No refractory DO was identified, and no second augmentation procedure was required during the follow-up period. Two children had a Bricker (7%) due to cognitive impairment preventing self-catheterizing.
Conclusion:
BA with clam cystoplasty seems a safe and effective treatment for children with neurological bladder. The re-intervention rate is comparable to current literature, and long-term urodynamic parameters demonstrate sustained improvements. The absence of refractory DO and additional augmentation procedures highlight the favorable long-term outcomes of this surgical approach.
