Introduction: A bladder outlet procedure (BOP) without augmentation cystoplasty (AC) for incontinence due to neurogenic bladder (NGB) is associated with risk of upper tract changes, chronic kidney disease (CKD), and need for additional surgeries. A cohort of patients who underwent BOP without AC from 2000-2013 was previously reported. From 2014 to present, BOP without AC has been used selectively. Here, we present extended outcomes, hypothesizing that BOP without AC in patients with high preoperative compliance (=20 mL/cm H2O) is associated with fewer adverse outcomes. Methods: A retrospective chart review was performed and longitudinal dataset created. Cumulative incidence of outcomes up to 15 years were calculated. The association of preoperative bladder compliance with adverse outcomes was studied by log-rank test. Results: 120 patients underwent BOP without AC from 2000-2020 at a median age of 7.5 years (Interquartile range (IQR) 5.8-11.5), with a median follow up of 10.1 years (IQR 7.1-13.3). Table 1 displays the 1, 5, 10, and 15 year cumulative incidences of outcomes. At 15 years, the cumulative incidence of AC was 42% and CKD was 48%. The most common indications for AC were small bladder capacity (25/37 patients, 76%), elevated detrusor pressure (24/37, 73%), incontinence (20/37, 61%), and new or worsening renal scarring (8/37, 24%). Of 87 patients with preoperative urodynamics available, a preoperative bladder compliance = 20 mL/cm H2O (32/87, 37%) was associated with a lower incidence of subsequent AC and abnormal DMSA (Figure 1). Conclusions: BOP without AC carries a significant risk of adverse outcomes including additional surgeries, upper tract changes, and CKD when used non-selectively. Patients with a preoperative bladder compliance = 20 mL/cm H2O may have a lower risk of adverse outcomes. These results support the selective use of BOP without AC in NGB patients with large, compliant bladders but long-term monitoring is needed. SOURCE OF Funding: None
