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Journal of Pediatric Urology, vol.22, no.4, 2026 (SCI-Expanded, Scopus)
Introduction Patients with certain lower urinary tract anomalies may develop high-pressure, low-capacity bladders, risking incontinence and upper urinary tract damage. If conservative treatments fail, augmentation surgery aims to improve bladder capacity, maintain continence, and protect the upper urinary tract. Long-term follow-up is vital, as over half of patients may require reoperations, making identification of risk factors and optimal management important. Aim To evaluate factors influencing the risk of reoperation, upper urinary tract deterioration (UUTD), and incontinence in children undergoing ileal augmentation (IA). Patients and methods A retrospective analysis was conducted on 131 patients who underwent IA surgery between July 1991 and January 2023 at a single center. Data included demographics, etiology, vesicoureteral reflux (VUR), preoperative renal function, anti-reflux surgery, bladder neck procedures, and catheterizable stoma procedures (CSP; Mitrofanoff/Monti). Factors affecting postoperative incontinence, UUTD, and reoperation rates were analyzed. Results The mean age at operation was 9.5 ± 4.95 years, with 55 males and 76 females. Over a median follow-up of 65 months, new-onset UUTD was observed in 33 patients (25.2 %). Anti-reflux surgery (p = 0.033) and preoperative chronic renal disease (CRD) (p = 0.045) were significant in univariate analysis. A total of 91 reoperations were performed on 45 patients (34.3 %). Multivariate analysis identified bladder exstrophy–epispadias complex (BEEC, p = 0.013) and CSP (p = 0.022) as significant risk factors for reoperation. Postoperative incontinence occurred in 34 patients (25.9 %), with BEEC being significant in multivariate analyses (p < 0.001). Patients with follow-up exceeding 10 years had higher reoperation risk (48.3 % vs. 30.4 %, p = 0.081), though not statistically significant. Incontinence (27.6 % vs. 23.5 %, p = 0.633) and UUTD (27.6 % vs. 24.5 %, p = 0.809) rates were similar. Discussion BEEC is associated with higher postoperative incontinence and reoperation risks. CSP was associated with higher reoperation risks. Longer follow-up periods did not seem to affect incontinence and UUTD rates, but reoperation rates seem to be higher. Conclusion IA is a complex surgery requiring long-term follow-up. Certain patient groups are under higher risk for incontinence and reoperation. Longer follow-up periods may lead to higher reoperation rates. Clinical applicability Given the pediatric nature of this patient group and their long life expectancy, better knowledge of the long-term outcomes, complications, and the need for reoperations will aid in management of these complications and provide useful information for families towards the prognosis of this surgery.