Utilization of Augmentation Cystoplasty for Myelomeningocele Patients Remained Stable Over the Past Decade



      To understand the utilization of augmentation cystoplasty (AC) for the management of neurogenic bladder in children with myelomeningocele (MMC). AC carries considerable risk. To mitigate this, recent studies have emphasized alternatives to AC, but it is unknown if these interventions have resulted in fewer ACs being performed. Our goal was to evaluate the use of AC in MMC patients over the past decade. We hypothesized that the use of AC had decreased and that the age at AC increased.


      Using the Pediatric Health Information System, we studied patients with MMC who had an AC between January 2009 and December 2018. International Classification of Disease procedure codes were used to identify AC procedures. We quantified trends in AC utilization by estimating the annual proportion of MMC admissions with an AC. We also assessed trends in patient age at the time of AC.


      Proportion of AC per MMC admissions across the study period was 4.8%. There was no significant annual trend in the overall number of ACs performed each quarter over the past decade nor was there any change in the estimated annual incidence rate ratio of AC (1.01, 95% confidence interval 0.96, 1.05; P =.75). The estimated annual change in patient age at procedure remained relatively constant over the study period (−0.03 years, 95% confidence interval −0.13, 0.07; P = .51).


      Practice patterns for the utilization of AC in MMC did not change significantly over the past decade despite prominent voices in the literature emphasizing alternative interventions in this patient population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ouyang L
        • Bolen J
        • Valdez R
        • Joseph D
        • Baum MA
        • Thibadeau J
        Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system.
        J Urol. 2015; 193: 558-564
        • Lapides J
        • Diokno AC
        • Silber SJ
        • Lowe BS
        Clean, intermittent self-catheterization in the treatment of urinary tract disease.
        J Urol. 1972; 107: 458-461
        • Schlomer BJ
        • Saperston K
        • Baskin L
        National trends in augmentation cystoplasty in the 2000s and factors associated with patient outcomes.
        J Urol. 2013; 190: 1352-1357
        • Kaefer M
        • Pabby A
        • Kelly M
        • Darbey M
        • Bauer SB
        Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele.
        J Urol. 1999; 162: 1068-1071
        • Schulte-Baukloh H
        • Michael T
        • Schobert J
        • Stolze T
        • Knispel HH
        Efficacy of botulinum-a toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary results.
        Urology. 2002; 59 (discussion 327-328): 325-327
        • Schulte-Baukloh H
        • Michael T
        • Stürzebecher B
        • Knispel HH
        Botulinum-a toxin detrusor injection as a novel approach in the treatment of bladder spasticity in children with neurogenic bladder.
        Eur Urol. 2003; 44: 139-143
        • Marte A
        Onabotulinumtoxin a for treating overactive/poor compliant bladders in children and adolescents with neurogenic bladder secondary to myelomeningocele.
        Toxins (Basel). 2012; 5: 16-24
        • Snodgrass WT
        • Elmore J
        • Adams R
        Bladder neck sling and appendicovesicostomy without augmentation for neurogenic incontinence in children.
        J Urol. 2007; 177 (discussion 1515): 1510-1514
        • Snodgrass W
        • Barber T
        Comparison of bladder outlet procedures without augmentation in children with neurogenic incontinence.
        J Urol. 2010; 184: 1775-1780
        • Wang HH
        • Lloyd JC
        • Wiener JS
        • Routh JC
        Nationwide Trends and variations in urological surgical interventions and renal outcome in patients with spina bifida.
        J Urol. 2016; 195: 1189-1194
        • Biers SM
        • Venn SN
        • Greenwell TJ
        The past, present and future of augmentation cystoplasty.
        BJU Int. 2012; 109: 1280-1293
        • Lendvay TS
        • Cowan CA
        • Mitchell MM
        • Joyner BD
        • Grady RW
        Augmentation cystoplasty rates at children's hospitals in the United States: a pediatric health information system database study.
        J Urol. 2006; 176: 1716-1720
        • Routh JC
        • Cheng EY
        • Austin JC
        • et al.
        Design and methodological considerations of the centers for disease control and prevention urologic and renal protocol for the newborn and young child with spina bifida.
        J Urol. 2016; 196: 1728-1734
        • Snodgrass W
        • Granberg C
        Clinical indications for augmentation in children with neurogenic urinary incontinence following bladder outlet procedures: results of a 14-year observational study.
        J Pediatr Urol. 2016; 12 (46.e41-48)
        • Grimsby GM
        • Menon V
        • Schlomer BJ
        • et al.
        Long-Term outcomes of bladder neck reconstruction without augmentation cystoplasty in children.
        J Urol. 2016; 195: 155-161