Laparoscopic laser assisted auto-augmentation of the pediatric neurogenic bladder: early experience with urodynamic followup.

Abstract

We report our initial experience with laparoscopic laser assisted bladder auto-augmentation for treatment of the symptomatic pediatric neurogenic bladder. Laparoscopic auto-augmentation of the bladder was performed in 2 children with myelodysplasia and high pressure neurogenic bladders unresponsive to medical management. Detrusorotomy was done using the KTP-532 laser. Laser energy was directed to the tissue to evaluate long-term effects of the procedure. Laparoscopic bladder auto-augmentation can be performed easily and with less morbidity compared to open auto-augmentation. Although results at 6 weeks showed improvement, enterocystoplasty was ultimately performed in both cases due to symptomatic recurrence of incontinence associated with increasing peak detrusor pressure and decreasing compliance. While this technique has the potential to offer minimally invasive correction in patients with low capacity, high pressure bladders, further modifications will be required to achieve long-term success.