Presentation Authors: Philip Cheng*, Sorena Keihani, Salt Lake City, UT, Sanchita Bose, Rose Khavari, Houston, TX, Sean Elliott, Joseph Pariser, Joshua Roth, Minneapolis, MN, Blayne Welk, London, Canada, Michael Kennelly, Cameron Futral, Chapel Hill, NC, David Ginsberg, Los Angeles, CA, Christopher Elliott, San Jose, CA, Kyla Valaer, Palo Alto, CA, Sara Lenherr, Salt Lake City, UT, Yahir Santiago-Lastra, San Diego, CA, John Stoffel, Ann Arbor, MI, Jeremy Myers, Salt Lake City, UT
Introduction: The objective of this study is to evaluate the outcomes of bladder augmentation in the adult population in a multicenter study. A secondary objective is to compare outcomes between patients who underwent a concomitant catheterizable channel placement vs. those who underwent a bladder augmentation alone.
Methods: We reviewed the charts of 193 patients from 7 sites from the Neurogenic Bladder Research Group who underwent bladder augmentation between July 2007 and September 2017. 23 patients were excluded due to age under 18 (2) or follow-up < 6 months (21). We evaluated patient demographics, modality and type of surgery, 90-day complications and readmissions, and follow-up surgeries.
Results: A total of 170 patients with a median age of 37 years were included in the study. 73 (43%) patients were male and the leading etiologies were spinal cord injury (81, 47%) and spina bifida (25, 15%). Prior to surgery, most patients' bladder management was clean intermittent catheterization (76, 45%), followed by indwelling urethral catheter or suprapubic tube (61, 36%). 137 (81%) patients underwent a bladder augmentation with a catheterizable channel, while 33 (19%) patients underwent a small bowel augmentation alone. The median length of hospital stay was 8 days (IQR 7-11) for channel patients and 7 days (IQR 6-10) for augment-only patients. The 90-day major complication rate was 13% (22 patients), which included 17 (12%) channel patients and 5 (15%) augment-only patients (p = 0.40). In the 90-day post-operative period, 33 (19%) patients were readmitted and there were 0 deaths; there were no statistically significant differences between the two groups. Beyond the 90-day period, 64 patients (38%) underwent a total of 90 surgeries related to their bladder augment. 6 of the 33 (18%) augment-only patients underwent 9 surgeries while 58 of the 137 (42%) channel patients underwent 81 surgeries (p = 0.01), 36 of which were for channel-specific complications (i.e. stenosis, leakage, and parastomal hernia).
Conclusions: This is the first contemporary multicenter series evaluating bladder augmentation in the adult population. 90-day major complication rates were low, but many of these patients--primarily the ones with catheterizable channels--required follow-up surgeries.