Introduction: Neurogenic bladder dysfunction is a complex diagnosis in the pediatric population, often requiring lifelong surveillance and management. Surgical intervention can include an augmentation cystoplasty procedure to increase bladder capacity and reduce bladder pressures. This population is at increased risk of developing urinary tract infections (UTIs). The primary objective of this study was to evaluate the frequency of treated UTIs in patients undergoing augmentation cystoplasty procedures pre- and postoperatively. Secondary objectives included reviewing the etiology of bladder dysfunction, rates of continuous antibiotic prophylaxis use, and bladder capacity and pressure on urodynamic evaluation.

Methods: A retrospective review was performed evaluating pediatric patients at our center undergoing a bladder augmentation procedure under the care of a single surgeon from 2006–2020. A bladder augmentation was defined as a procedure using a segment of bowel to increase a patient’s bladder capacity. Variables assessed included patient age, gender, etiology of bladder dysfunction, length of bowel used, UTI frequency, other urological procedures performed, and bladder capacity and pressures assessed on urodynamics. A UTI was defined as a positive urine culture for which an antibiotic was prescribed by a physician. Descriptive statistics, t-test, and Chi-squared analysis were performed where appropriate using SPSS v25.

Results: A total of 37 patients were included with an average age of 13.1 years and 62% (n=23) being male. The etiology of bladder dysfunction was spina bifida in 65% (n=24), bladder exstrophy in 11% (n=4), cloacal malformation in 5% (n=2), posterior urethral valves in 5% (n=2), cerebral palsy in 5% (n=2), neuroblastoma in 3% (n=1), and Robinow syndrome in 3% (n=1). The average length of ileum used was 24.2 cm. The average number of bacteriuria episodes treated as a UTI in the two years pre-augmentation was less than the two years post-augmentation (1.2 vs. 2.9 episodes, p<0.001). Continuous antibiotic prophylaxis was used in 8% (n=3) pre-augmentation and in 11% (n=4) post-augmentation. The measured maximum cystometric capacities in patients increased from 198 cc to 441 cc with augmentation (p<0.001) and there was a reduction in peak bladder pressures, with a decrease from 41 mmHg to 18 mmHg (p<0.001).

Conclusions: Patients undergoing augmentation cystoplasty are at increased risk of developing asymptomatic bacteriuria and UTI requiring treatment. There is a risk of overtreatment for UTI in this patient population, and further prospective analysis is required to evaluate the accuracy and clinical indications for treatment.