==== Front Int Braz J Urol Int Braz J Urol ibju International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology 1677-5538 1677-6119 Sociedade Brasileira de Urologia 33047925 S1677-5538.IBJU.2021.01.04 10.1590/S1677-5538.IBJU.2021.01.04 Update in Urology Neuro-Urology Editorial Comment: Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review https://orcid.org/0000-0002-8127-7153Averbeck Marcio Augusto 1 1 Hospital Moinhos de Vento Unidade de Videourodinâmica Porto AlegreRS Brasil Chefe de Neuro-Urologia, Unidade de Videourodinâmica, Hospital Moinhos de Vento. Porto Alegre, RS, Brasil Marcio Averbeck, MD, PhD, Unidade de Videourodinâmica, Hospital Moinhos de Vento. Porto Alegre, RS, Brasil. E-mail: marcioaverbeck@gmail.com1 Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands 2 Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom 3 Department of Urology, Aix Marseille University, Marseille, France 4 Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France 5 Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain CONFLICT OF INTEREST None declared. 18 11 2020 Jan-Feb 2021 47 1 191 192 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ==== Body Hoen L’ 1, Ecclestone H 2, Blok BFM 1, Karsenty G 3, Phé V 4 5,Bossier R 3 et al. COMMENT International guidelines support a timely diagnosis and an individualized treatment to prevent upper and lower urinary tract deterioration in neuro-urological patients (1, 2). Reconstructive surgery may be needed in high-risk patients, who failed conservative treatment for neurogenic detrusor overactivity (3). Hoen et al. performed a PRISMA systematic review to evaluate effectiveness and safety of bladder augmentation for adult neuro-urological patients. A total of 20 studies including 511 patients were eligible for inclusion. Primary outcomes were assessed in 16 of the 20 studies and showed improved quality of life and anatomical changes as well as stable renal function. Continence rates were reported in only 14 series. A total of 225 patients either were incontinent or had an indwelling catheter preoperatively. Only 30 patients were not completely continent postoperatively (87% success rate). Long-term complications continued up to 10 years postoperatively, including bowel dysfunction in 15% of the patients, stone formation in 10%, five bladder perforations and one bladder cancer. These outcomes reinforce both the role of bladder augmentation in high-risk neuro-urological patients and the importance of longer-term follow-up. However, the studies included in this systematic review had a low-level of evidence (mostly level 4; only one level 3 study). Therefore, further research initiatives should include structured quality of life assessments, detailed description of inclusion and exclusion criteria, surgical technique and post-operative complications. Perhaps an international registry/working group may overcome these inherent limitations and increase the level of evidence in the near future. ==== Refs REFERENCES 1 Groen J Pannek J Castro Diaz D Del Popolo G Gross T Hamid R Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology Eur Urol 2016 69 324 333 26304502 1. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 2016;69:324-33. 2 Sekido N Igawa Y Kakizaki H Kitta T Sengoku A Takahashi S Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury Int J Urol 2020 27 276 288 32077161 2. Sekido N, Igawa Y, Kakizaki H, Kitta T, Sengoku A, Takahashi S, et al. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Int J Urol. 2020;27:276-88. 3 Hamid R Averbeck MA Chiang H Garcia A Al Mousa RT Oh SJ Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury World J Urol 2018 36 1517 1527 29752515 3. Hamid R, Averbeck MA, Chiang H, Garcia A, Al Mousa RT, Oh SJ, et al. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World J Urol. 2018;36:1517-27.