1358 NATIONAL TRENDS IN AUGMENTATION CYSTOPLASTY

damage? The absence of objective criteria toperform AC and the institutional variability re-ported by Lendvay et al (reference 18 in article)may also compromise the reliability of these esti-mated numbers.

Sumit DaveDivisions of Urology and Pediatric Surgery

Schulich School of Medicine and Dentistry

Western University

London, Ontario, Canada

REPLY BY AUTHORS

We reported a decreasing total number of ACs per- positive or negative effect on long-term outcomes

formed in the United States during the 2000s. Giventhe limitations of the data set, we do not have thedenominator of total number of patients with spinabifida being followed in the United States duringthe 2000s to calculate a truly clinically meaningfulAC rate. As stated in the discussion, we can onlyspeculate as to the reasons that the total number ofACs has decreased. Changing practice patterns ofpediatric urologists could be one of many reasons.We do not agree that we can assume that a de-creased number of ACs in this population has had a

of this population. We simply do not have that in-formation. We are hopeful that this series spursmore interest in collaborative study of the questionsraised by Dave. Other points to take away from thisstudy include the fact that the overall risk of com-plications during hospitalization following surgeryis not insignificant, and a large minority of ACs arebeing performed in the bladder exstrophy popula-tion, and these patients appear to be at risk forlonger hospital stays and immediate postoperativecomplications.