Long-term outcomes and complications of augmentation cystoplasty in pediatric neurogenic bladder patients: A systematic review and meta-analysis

Augmentation cystoplasty (AC) is a surgical procedure used to manage pediatric neurogenic bladder (NB) when conservative treatments fail. While AC improves bladder function and continence, it carries significant long-term risks. This systematic review and meta-analysis evaluate the functional benefits and complications of AC in pediatric NB patients. A comprehensive search of PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov , and the Cochrane Library was conducted from inception until February 14, 2025. Eligible studies included pediatric patients (≤18 years) with NB who underwent AC. Primary outcomes were continence improvement and bladder capacity increase, while secondary outcomes included complications such as bladder stones, perforation, and reoperation rates. A one-group meta-analysis was performed using logit transformation for categorical outcomes and weighted mean differences (WMD) for continuous outcomes. Heterogeneity was assessed using I 2 statistics. Nine retrospective cohort studies comprising 696 pediatric patients were included. The pooled continence improvement rate was 78.1% (95% CI: 62–89%), and bladder capacity increased by 82.1% (95% CI: 64.3–99.9%). The incidence of bladder stones was 19.3%, bladder perforation was 6.0%, and reoperation occurred in 24% of cases. Significant heterogeneity was observed for reoperation rates (I 2 = 97%). AC effectively improves continence and bladder capacity in pediatric NB patients, but it carries a substantial risk of complications. The high reoperation and complication rates underscore the need for careful patient selection, standardized surgical techniques, and structured follow-up. • Augmentation cystoplasty (AC) improved continence in 78% of pediatric neurogenic bladder patients. • Bladder capacity increased by an average of 82% after AC. • Bladder stones occurred in 19.3% of patients post-AC. • Bladder perforation and reoperation rates were 6.0% and 24%, respectively. • High complication rates emphasize the need for lifelong follow-up and patient selection.