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

Purpose: We report our initial experience with laparoscopic laser assisted bladder autoaugmentation for treatment of the symptomatic pediatric neurogenic bladder. Materials and Methods: 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 using a backstop laser delivery device. Both patients were followed with urodynamic studies to evaluate long-term effects of the procedure. Results: 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. Conclusions: 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.