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Lee AH, Ramirez AL, Krassioukov AV, Walter M. Long-term neurogenic lower urinary tract dysfunction: A case of cardiovascular nightmares. J Spinal Cord Med 2021; 44:806-810. [PMID: 31140958 PMCID: PMC8477941 DOI: 10.1080/10790268.2019.1617919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Individuals with spinal cord injury (SCI) suffering from autonomic dysreflexia (AD) due to neurogenic detrusor overactivity (NDO) can effectively be treated with intradetrusor onabotulinumtoxinA. We present a complex case to highlight the treatment's potential limitations to ameliorate AD and improve lower urinary tract (LUT) function in this population. FINDINGS A 46-year old man, who was relying on an indwelling urethral catheter for bladder emptying due to severely impaired hand function following a SCI (C5, AIS B) sustained 30 years ago, underwent intradetrusor onabotulinumtoxinA injections for treatment of refractory NDO and associated AD. Although LUT function slightly improved (i.e. cystometric capacity increased while detrusor pressure was reduced), severe bladder-related AD persisted post-treatment. CONCLUSIONS This case raises awareness of serious considerations when treating NDO-related AD in individuals with longstanding neurogenic LUT dysfunction and compromised dexterity following SCI. Given the limited improvement in LUT function and persisting bladder-related AD following treatment, urinary diversion as advocated in the wider literature should be considered to protect an individual's urinary tract from further deterioration and thus eliminate bladder-related AD consequences long-term. Early treatment and management of NDO and AD is crucial to minimize complications associated with these two major health risks in this population.
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Affiliation(s)
- Amanda H.X. Lee
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea L. Ramirez
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada,Correspondence to: Andrei V. Krassioukov, ICORD-BSCC, 818 West 10th Avenue, Vancouver, BC, Canada, V5Z 1M9; Ph: + (604) 675-8819. E-mail:
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Mizuno H, Honda F, Ikota H, Yoshimoto Y. Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report. BMC Neurol 2021; 21:252. [PMID: 34187375 PMCID: PMC8240206 DOI: 10.1186/s12883-021-02271-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. CASE PRESENTATION The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. CONCLUSIONS AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.
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Affiliation(s)
- Hiroyuki Mizuno
- Departments of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Gunma, 371-8511, Maebashi, Japan.
| | - Fumiaki Honda
- Departments of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Gunma, 371-8511, Maebashi, Japan
| | - Hayato Ikota
- Departments of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Maebashi, Japan
| | - Yuhei Yoshimoto
- Departments of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Gunma, 371-8511, Maebashi, Japan
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3
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Taghavi K, O'Hagan LA, Bortagaray J, Bouty A, M Hutson J, O'Brien M. Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20-year review. ANZ J Surg 2021; 91:1005-1010. [PMID: 33844426 DOI: 10.1111/ans.16736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. METHODS Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999-2019). Short- and long-term outcomes and complications following augmentation cystoplasty were defined. RESULTS Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy-epispadias complex (30%) and posterior urethral valves (23%). The most common tissue-type utilized was ileal (58%) and ureteric (30%). Peri-operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end-of-study detrusor pressure improved significantly following bladder augmentation (38-17 cmH2 O, P < 0.001). Bladder capacity improved significantly (67-89%, P = 0.041). The median follow-up was 4.5 years (interquartile range: 1.9-10 years). Bladder urolithiasis affected 13 (18%) patients, and symptomatic urinary tract infections 36 (51%) patients. Formation of a continent catheterisable channel contributed a number of complications relating predominantly to stenosis (50%). Repeat augmentation cystoplasty was necessary in three (4%) cases. CONCLUSION Augmentation cystoplasty is a surgical intervention that improves bladder metrics. Given the potential complications, careful patient selection and appropriate pre-operative counselling are essential. Furthermore, pro-active post-operative management and transitional care are vital in the surgical care of children following augmentation cystoplasty.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lomani A O'Hagan
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Juan Bortagaray
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Aurore Bouty
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John M Hutson
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Mike O'Brien
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
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4
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Flack CK, Mellon MJ. Current Management Strategies for Autonomic Dysreflexia. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0488-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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5
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Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn 2017; 36:882-893. [DOI: 10.1002/nau.23170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Arun Sahai
- Department of Urology; Guy's and St.Thomas’ Hospitals; London UK
| | | | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | - Dudley Robinson
- Department of Urogynaecology; King's College Hospital; NHS Foundation Trust; London UK
| | - Stavros Gravas
- Department of Urology; University of Thessaly; Larissa Greece
| | - Roger Dmochowski
- Department of Urology; Vanderbilt University; Nashville Tennesse
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6
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Hoen L', Ecclestone H, Blok BFM, Karsenty G, Phé V, Bossier R, Groen J, Castro-Diaz D, Padilla Fernández B, Del Popolo G, Musco S, Pannek J, Kessler TM, Gross T, Schneider MP, Hamid R. Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review. Neurourol Urodyn 2017; 36:1685-1702. [PMID: 28169459 DOI: 10.1002/nau.23205] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/03/2016] [Accepted: 11/16/2016] [Indexed: 11/09/2022]
Abstract
AIMS To systematically evaluate effectiveness and safety of bladder augmentation for adult neuro-urological patients. METHODS The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement was followed for review of publications. The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched until January 2015. No limitations were placed on date or language. Non-original articles, conference abstracts, and publications involving children and animals were excluded. Risk-of-bias and confounder assessment was performed. RESULTS A total of 20 studies including 511 patients were eligible for inclusion. The level of evidence for the included studies was low, most level 4 studies with only one level 3 study. The data were narratively synthesized. Across all studies high risk-of bias and confounding was found. 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. The secondary outcomes were reported in 17 of the 20 studies and urodynamic parameters and continence all demonstrated improvement after bladder reconstruction. Long-term complications continued up to 10 years post-operatively, including bowel dysfunction in 15% of the patients, stone formation in 10%, five bladder perforations and one bladder cancer. CONCLUSIONS Available studies are not plentiful and of relatively poor quality, appropriately designed prospective studies are urgently needed. Despite this, bladder augmentation appears to be a highly effective procedure at protecting the upper urinary tract and improving quality of life. However, it is associated with relatively high morbidity in both the short and long term.
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Affiliation(s)
- Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hazel Ecclestone
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.,Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Romain Bossier
- Department of Urology, Aix Marseille University, Marseille, France
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David Castro-Diaz
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.,Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Bárbara Padilla Fernández
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.,Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Stefania Musco
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom
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7
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Zhang HC, Yang J, Ye X, Hu HF. Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux. Kaohsiung J Med Sci 2016; 32:323-6. [PMID: 27377846 DOI: 10.1016/j.kjms.2016.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 02/05/2023] Open
Abstract
The objective of this study was to assess the clinical outcome of vesicoureteral reflux (VUR) after augmentation cystoplasty alone in patients with a hypocompliant neurogenic bladder. Between January 2009 and December 2014, 29 patients with a hypocompliant bladder associated with VUR confirmed by videourodynamics (VUD) preoperatively were recruited in this study. All patients had undergone bladder augmentation with a generous detubularized segment of bowel at our institution. No effort had been made to correct the existing reflux. Preoperative assessment included urinalysis, kidney function tests, ultrasonography, and videourodynamic evaluation. All patients had various degrees of VUR. The status of VUR and bladder function were studied by VUD. The mean follow-up period was 2.2 years (range 0.5-5.5 years). The VUD manifested a significant improvement of bladder capacity, diminution of intravesical pressure, and resolution of reflux after bladder augmentation. After the surgery, 24/29 (83%) no longer had reflux, 3/29 (10%) showed improvement in reflux, and 2/29 (7%) demonstrated no change in reflux. In addition, 16/21 (76%) patients had reflux Grades I-III; 100% patients with reflux Grades IV and V had complete cessation of reflux. Only one patient had symptomatic urinary infection after the surgery. Augmentation enterocystoplasty without ureteral reimplantation is thus effective and adequate for patients with high-pressure and hypocompliant neurogenic bladder. Therefore, ureteral reimplantation is not necessary when augmentation enterocystoplasty is recommended for patients with high-pressure, low-compliant bladder and VUR.
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Affiliation(s)
- Han-Chao Zhang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, PR China.
| | - Jin Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, PR China
| | - Xin Ye
- Department of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Hai-Feng Hu
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, PR China
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8
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Abstract
Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.
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Affiliation(s)
- Waleed Al Taweel
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raouf Seyam
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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9
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Autonomic Dysreflexia: Evaluation and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Brown JM, Barbe MF, Albo ME, Ruggieri MR. Anatomical feasibility of performing a nerve transfer from the femoral branch to bilateral pelvic nerves in a cadaver: a potential method to restore bladder function following proximal spinal cord injury. J Neurosurg Spine 2013; 18:598-605. [PMID: 23540734 PMCID: PMC3745765 DOI: 10.3171/2013.2.spine12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Nerve transfers are an effective means of restoring control to paralyzed somatic muscle groups and have recently been shown to be effective in denervated detrusor muscle in a canine model. A cadaveric study was performed to examine the anatomical feasibility of transferring femoral muscular nerve branches to vesical branches of the pelvic nerve as a method of potentially restoring innervation to control the detrusor muscle in humans. METHODS Twenty cadavers were dissected bilaterally to expose pelvic and femoral muscular nerve branches. Ease of access and ability to transfer the nerves were assessed, as were nerve cross-sectional areas. RESULTS The pelvic nerve was accessed at the base of the bladder, inferior to the ureter, and accompanied by inferior vesical vessels. Muscular branches of the femoral nerve to the vastus medialis and intermedius muscles (L-3 and L-4 origins) were followed distally for 17.4 ± 0.8 cm. Two muscle branches were split from the femoral nerve trunk, and tunneled inferior to the inguinal ligament. One branch was moved medially toward the base of the bladder and linked to the ipsilateral pelvic nerve. The second branch was tunneled superior to the bladder and linked to the contralateral pelvic nerve. The cross-sectional area of the pelvic nerve vesical branch was 2.60 ± 0.169 mm(2) (mean ± SEM), and the femoral nerve branch at the suggested transection site was 4.40 ± 0.41 mm2. CONCLUSIONS Use of femoral nerve muscular branches from the vastus medialis and intermedius muscles for heterotopic nerve transfer of bilateral pelvic nerves is surgically feasible, based on anatomical location and cross-sectional areas.
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Affiliation(s)
- Justin M. Brown
- Division of Neurosurgery, University of California at San Diego School of Medicine
| | - Mary F. Barbe
- Departments of Anatomy & Cell Biology, Temple University School of Medicine, Philadelphia, PA
| | - Michael E. Albo
- Division of Urology, University of California at San Diego School of Medicine
| | - Michael R. Ruggieri
- Departments of Anatomy & Cell Biology, Temple University School of Medicine, Philadelphia, PA
- Shriners Hospital of Philadelphia, Philadelphia, PA
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11
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Vainrib M, Reyblat P, Ginsberg DA. Differences in urodynamic study variables in adult patients with neurogenic bladder and myelomeningocele before and after augmentation enterocystoplasty. Neurourol Urodyn 2012; 32:250-3. [DOI: 10.1002/nau.22304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/06/2012] [Indexed: 11/08/2022]
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12
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Noguera RJS, Astigueta JC, Carmona O, De Andrade RJ, Luis S, Cuomo B, Manrique J, Gill IS, Desai MM. Laparoscopic Augmentation Enterocystoplasty Through a Single Trocar. Urology 2009; 73:1371-4. [DOI: 10.1016/j.urology.2009.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 01/14/2009] [Accepted: 01/26/2009] [Indexed: 02/04/2023]
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13
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Krassioukov A, Warburton DER, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 2009; 90:682-95. [PMID: 19345787 PMCID: PMC3108991 DOI: 10.1016/j.apmr.2008.10.017] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 07/25/2008] [Accepted: 10/06/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD). DATA SOURCES A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD. STUDY SELECTION Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded. DATA EXTRACTION Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers. DATA SYNTHESIS Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E(2)). CONCLUSIONS A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from noncontrolled trials, and more rigorous trials are required.
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Affiliation(s)
- Andrei Krassioukov
- International Collaboration on Repair Discoveries (ICORD)
- Division of Physical Medicine and Rehabilitation, University of BC, Vancouver, Canada
- Department of Physical Therapy, University of BC, Vancouver, Canada
| | - Darren ER Warburton
- International Collaboration on Repair Discoveries (ICORD)
- Cardiovascular Physiology and Rehabilitation Laboratory & Experimental Medicine, University of BC, Vancouver, Canada
| | - Robert Teasell
- Department of Physical Medicine & Rehabilitation, University of Western Ontario, London, ON, Canada
| | - Janice J Eng
- International Collaboration on Repair Discoveries (ICORD)
- Department of Physical Therapy, University of BC, Vancouver, Canada
- Rehabilitation Research Laboratory, GF Strong Rehab Centre, Vancouver, Canada
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14
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Laparoscopic Augmentation Ileocystoplasty: Results and Outcome. Eur Urol 2009; 55:721-7. [DOI: 10.1016/j.eururo.2008.03.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 03/22/2008] [Indexed: 11/23/2022]
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15
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Youssif M, Badawy H, Saad A, Hanno A, Mokhless I. Augmentation ureterocystoplasty in boys with valve bladder syndrome. J Pediatr Urol 2007; 3:433-7. [PMID: 18947790 DOI: 10.1016/j.jpurol.2007.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Children with valve bladder syndrome represent the worst end of the posterior urethral valve spectrum. When conservative measures fail to control recurrent infections, prevent deterioration of the upper tract (in the form of increasing hydronephrosis and or worsening of kidney function) and improve incontinence, augmentation cystoplasty is considered. In most of these boys, renal insufficiency precludes the use of intestine for augmenting the bladder. Our aim was to evaluate the efficacy and safety of ureterocystoplasty in managing children with valve bladder syndrome. PATIENTS AND METHODS Eight boys (mean age 5 years) with valve bladder syndrome were included in this study. All boys had successful valve ablation at the time of presentation. When conservative treatment failed, ureterocystoplasty was scheduled. The entire ureter was folded and used in four boys after nephrectomy for a non-functioning kidney. The lower dilated ureter was used to augment the bladder, and transureteroureterostomy in two and re-implantation of the remaining ureter in two were performed. Radiological and urodynamic investigation was performed preoperatively and postoperatively at 3, 6 and 12 months. Improvement of hydroureteronephrosis was judged by ultrasound. RESULTS Bladder capacity (as measured during cystometry at 30 cmH(2)O) and compliance were significantly improved in all children following the procedure (P<0.001), and reached or exceeded the normal calculated capacity for age-matched boys. Hydroureteronephrosis improved in six boys (75%). The procedure avoids almost all the complications of enterocystoplasty. Clean intermittent self-catheterization was performed in all cases routinely after surgery, weaning off as judged by the voiding pattern of the child. CONCLUSION Ureterocystoplasty is an ideal option for augmenting the hypocompliant bladder in boys with valve bladder syndrome. The entire ureter or the dilated lower part can be used. This is a solution for boys with impaired renal function when enterocystoplasty cannot be performed.
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Affiliation(s)
- Mohamed Youssif
- Pediatric Urology Unit, Department of Urology, Alexandria University, Raml Station, Alexandria, Egypt.
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Game X, Karsenty G, Chartier-Kastler E, Ruffion A. Chapitre C-2 C - Traitement de l’hyperactivité détrusorienne neurologique : entérocystoplasties. Prog Urol 2007; 17:584-96. [PMID: 17622095 DOI: 10.1016/s1166-7087(07)92373-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The importance of a good capacity bladder reservoir able to fill at low pressure has now been clearly established. These properties have a double advantage: they ensure urinary continence and prevent damage to the upper urinary tract. In the case of failure of the various medical treatments, including botulinum toxin injections, surgical bladder augmentation can be considered, especially in the presence of poor bladder compliance. The authors present the technical details of bladder augmentation by enterocystoplasty or by alternative techniques and their medium- and long-term results, and define the postoperative surveillance of this type of surgery.
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Affiliation(s)
- X Game
- Service d'urologie, Centre hospitalo-universitaire de Toulouse, France.
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17
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Possover M, Baekelandt J, Kaufmann A, Chiantera V. Laparoscopic endopelvic sacral implantation of a Brindley controller for recovery of bladder function in a paralyzed patient. Spinal Cord 2007; 46:70-3. [PMID: 17420771 DOI: 10.1038/sj.sc.3102065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A number of techniques are being investigated to accomplish bladder control recovery in paralyzed patients using the neurostimulation, but currently, all techniques are based on the dorsal implantation of the electrodes using a laminectomy. METHODS On 27 April 2006 we performed a laparoscopic implantation of a Finetech-Brindley bladder controller on the endopelvic sacral roots in a Th8 completely paralyzed woman who had previously undergone the removal of a Brindley controller due to an arachnoiditis after extrathecal implantation with intradural sacral deafferentation. RESULTS We required about 3.5 h for the entire surgical procedure; no complications occurred and the patients went home on 5th postoperative day. The patient is now able to void empty her bladder and her rectum using the controller without further need for self-catheterisation. CONCLUSIONS The presented new technique of laparoscopic implantation of electrodes on the endopelvic portion of the sacral nerve roots is an option to be considered in all paralyzed patients with further wish for electrical induced miction/defecation after previous deafferentation.
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Affiliation(s)
- M Possover
- Department of Gynecology and Obstetrics, St Elisabeth Hospital, Cologne, Germany.
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Núñez Mora C, Cansino Alcaide R, Alonso Gregorio S, Martínez-Piñeiro LL, De la Peña Barthel J. Enterocistoplastia de ampliación laparoscópica: experiencia inicial. Actas Urol Esp 2007; 31:17-22. [PMID: 17410981 DOI: 10.1016/s0210-4806(07)73588-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the initial experience of our group in the realization of the augmentation enterocystoplasty by laparoscopyc approach. METHODS AND PATIENTS We describe the augmentation enterocystoplasty technique with ileal segment completely achieved by laparoscopyc approach. We present the cases of two patients suffering from hyperreflexic bladder refractory to medical treatment who underwent this surgery. In both cases the technique was realized without intraoperative complications although it was needed a surgical time of 6 and 4.5 hours respectively. The results after 12 and 5 months were satisfactory in both patients, obtaining a low pressure bladder with a good continence. CONCLUSIONS Laparoscopyc augmentation enterocystoplasty is a complicated technique that requires a great experience, mainly in laparoscopyc suture. It reproduces completely the open surgery and it offers all the advantages inherent to the laparoscopyc surgery.
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Affiliation(s)
- C Núñez Mora
- Servicio de Urología, Hospital Universitario La Paz, Universidad Autónoma de Madrid.
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Quek ML, Ginsberg DA. Long-term urodynamics followup of bladder augmentation for neurogenic bladder. J Urol 2003; 169:195-8. [PMID: 12478134 DOI: 10.1016/s0022-5347(05)64066-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Augmentation enterocystoplasty is well tolerated by patients with neurogenic bladder in whom conservative therapy has failed. However, few studies exist on long-term urodynamic evaluation of these patients. We assessed the clinical and urodynamic outcomes of patients with neurogenic bladder treated with augmentation enterocystoplasty with at least 4 years of followup. MATERIALS AND METHODS A total of 26 patients with neurogenic voiding dysfunction underwent augmentation enterocystoplasty alone or in conjunction with various continence or antireflux techniques. Clinical outcomes regarding incontinence, medications, catheterization schedule, subsequent interventions, bowel function and patient satisfaction were addressed. Urodynamic evaluation was performed to assess the long-term durability of bladder augmentation. RESULTS Mean followup was 8.0 years (range 4 to 13). All but 1 patient (96%) in our series had near or complete resolution of urinary incontinence. Mean total bladder capacity +/- SD increased from 201 +/- 106 to 615 +/- 204 ml. (p <0.001) and mean maximum detrusor pressure decreased from 81 +/- 43 to 20 +/- 12 cm. H O (p <0.01). Mean interval between catheterizations was 5 hours, with volumes ranging from 314 to 743 ml. Only 2 patients (8%) needed a low dose of oxybutynin postoperatively to maintain continence consistently. Of the 26 patients 23 (88%) reported no significant change in bowel function and nearly all patients expressed extreme satisfaction with urological management. A subsequent urological procedure was required in 12 patients (46%) at a mean of 4.4 years after initial surgery.(2) CONCLUSIONS Bladder augmentation provides durable clinical and urodynamic improvement for patients with neurogenic bladder dysfunction refractory to conservative therapy. Furthermore, there is a high level of patient satisfaction with bladder augmentation.
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Affiliation(s)
- Marcus L Quek
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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QUEK MARCUSL, GINSBERG DAVIDA. Long-Term Urodynamics Followup of Bladder Augmentation for Neurogenic Bladder. J Urol 2003. [DOI: 10.1097/00005392-200301000-00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodó J, Farré X, Martín E. Cyclophosphamide-induced hemorrhagic cystitis in rats that underwent colocystoplasty: experimental study. J Urol 2001; 165:660-6. [PMID: 11176454 DOI: 10.1097/00005392-200102000-00090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cyclophosphamide and its derivatives induce hemorrhagic cystitis. A substantial number of patients receive bladder augmentation or replacements using bowel. If patients who have undergone colocystoplasty need treatment with cyclophosphamide before or after the operation, does hemorrhagic cystitis develop? We evaluated the histological changes produced in the colon wall and bladder related to cyclophosphamide and its derivatives in rats that underwent colocystoplasty. MATERIALS AND METHODS Sprague-Dawley rats of each sex were grouped according to whether they received a single 200 mg./kg. dose of cyclophosphamide, underwent colocystoplasty, underwent each technique or served as controls. The technique of colocystoplasty was the same in all groups. Results were analyzed according to previously reported criteria, by the gross appearance of the bladder and colon segment used for colocystoplasty, and by histological changes. RESULTS Two weeks after surgery colocystoplasty had not resulted in secondary changes in the implanted colon segment or original bladder, while there were only nonspecific changes of an inflammatory type in the anastomotic area. After cyclophosphamide administration the animals lost considerable weight and in the bladder area we observed hemorrhagic cystitis that was greater in males than in females, and greater in isolated bladder than when the bladder was sutured to the colon segment. In the colon there was no inflammation or hemorrhage damage of the hemorrhagic cystitis type in the bladder. A total of 12 days after colocystoplasty there were no secondary histological changes except in the anastomotic area. A single 200 mg./kg. dose of cyclophosphamide caused substantial weight loss and hemorrhagic cystitis. Cystitis was quantitatively greater in males than in females and greater in isolated bladder than in bladder anastomosed to the colon. CONCLUSIONS Administering a single dose of cyclophosphamide did not result in lesions in the colon segment used for colocystoplasty analogous to those of the bladder, such as hemorrhagic cystitis.
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Affiliation(s)
- J Rodó
- Department of Surgery, Hospital Sant Joan de Déu and Department of Pathology, Hospital Clínic, Barcelona, Spain
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Abstract
Urologic management strategies in patients with spinal cord injury are discussed herein, and the underlying pathophysiology and urodynamic principles are emphasized. Contemporary management of the spinal cord-injured bladder has allowed for near-elimination of renal failure as the primary cause of long-term morbidity in these patients; low urine storage, sterile urine, and effective emptying are imperative for good long-term results.
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Affiliation(s)
- D J Lightner
- Department of Urology, Mayo Clinic Rochester, Minnesota, USA
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Larsen LD, Chamberlin DA, Khonsari F, Ahlering TE. Retrospective analysis of urologic complications in male patients with spinal cord injury managed with and without indwelling urinary catheters. Urology 1997; 50:418-22. [PMID: 9301708 DOI: 10.1016/s0090-4295(97)00224-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare, in a retrospective fashion, the long-term urologic complications in male patients with spinal cord injury managed with and without indwelling urinary catheters. METHODS The records of 142 consecutive male patients with traumatic spinal cord injuries sustained between 1975 and 1985 (inclusive) were reviewed. Fifty-six patients were managed with indwelling urinary catheters, and 86 were managed without an indwelling catheter. Urinary complications were recorded for each patient under the following general subheadings: renal, urinary tract infection, stones, urethral, and other. RESULTS In all, there were 95 complications in the noncatheterized group versus 202 in the catheterized group (P = 0.007). The catheterized group experienced significantly more problems with renal damage, recurrent urinary tract infection, stones, and urethral complications. CONCLUSIONS Our study shows that elimination of indwelling urinary catheters in patients with spinal cord injury will significantly reduce the incidence of urinary tract complications and lead to better preservation of renal function.
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Affiliation(s)
- L D Larsen
- Department of Urology, Long Beach Veterans Administration Medical Center, California, USA
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Hasan ST, Marshall C, Robson WA, Neal DE. Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction. BRITISH JOURNAL OF UROLOGY 1995; 76:551-7. [PMID: 8535671 DOI: 10.1111/j.1464-410x.1995.tb07777.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To study the long-term outcome of patients undergoing enterocystoplasty. PATIENTS AND METHODS The study comprised 48 patients (17 men and 31 women; mean age 46 years) who underwent enterocystoplasty for idiopathic detrusor instability (DI, 35 patients) or neurogenic bladder dysfunction (13 patients). Symptoms were scored from 0 to 14 and the overall outcome and generic quality of life were assessed using a Visick grading system (groups A to E) and the Nottingham Health Profile (NHP). These assessments were carried out before, 3 months after operation and at the final follow-up (38 +/- 18 months, range 13-78). Urodynamic studies were performed before and after operation. RESULTS No patient died after operation and there was minimal early morbidity. Late complications (> 30 days) included incisional hernia (3), anastomotic perforation (1), calculus formation (1) and urethral stricture (1). Clean intermittent self-catheterization (CISC) was performed by 36 (75%) patients. Early symptomatic outcome was good in 40 (83%) patients, moderate in seven (15%) and unsatisfactory in one (2%) patient. The mean symptom scores before and 3 months after surgery were 10 (range 2-14) and 3 (range 2-14), respectively (P < 0.001). There was a significant increase in total bladder capacity (307 +/- 140 to 588 +/- 217 mL; P < 0.001) and bladder compliance (37 +/- 50 to 169 +/- 162 mL/cm H2O; P < 0.001). DI persisted in 15 (31%) patients. NHP scores revealed significant improvements in all domains. Final assessment showed a less satisfactory situation, with recurrent urinary tract infection (UTI) in 17 (37%) patients, a need for long-term antibiotic therapy in seven (15%) and a change in bowel habit in 15 (33%) (13 DI, two with neurogenic bladder dysfunction). CISC was performed by 39 (85%) patients. The long-term outcome was good or moderate in 12 patients (92%) with neurogenic bladder dysfunction and good or moderate in only 19 patients (58%) with DI. CONCLUSION Clam enterocystoplasty remains an effective management option in some patients with DI, but most patients with neurogenic bladder dysfunction do well. The procedure is, however, associated with long-term complications such as disturbance of bowel habit and recurrent UTIs, which impair the outcome in the long-term in patients with DI despite general improvements in irritative bladder symptoms.
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Affiliation(s)
- S T Hasan
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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Bladder Augmentation Using the Stomach in Spinal Cord Injured Patients With Impaired Renal Function. Arch Phys Med Rehabil 1993. [DOI: 10.1016/s0003-9993(23)00021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Hollander JB, Diokno AC. URINARY DIVERSION AND RECONSTRUCTION IN THE PATIENT WITH SPINAL CORD INJURY. Urol Clin North Am 1993. [DOI: 10.1016/s0094-0143(21)00508-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chao R, Mayo ME, Bejany DE, Bavendam T. Bladder neck closure with continent augmentation or suprapubic catheter in patients with neurogenic bladders. THE JOURNAL OF THE AMERICAN PARAPLEGIA SOCIETY 1993; 16:18-22. [PMID: 8426180 DOI: 10.1080/01952307.1993.11735879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Twenty-four patients, with various combinations of non-healing decubitus ulcers, urethral fistulae, incontinence, and penile skin breakdown were candidates for proximal urinary diversion, having failed intermittent, external, and indwelling catheterization combined with pharmacologic therapy. Seventeen patients underwent bladder neck closure, including seven with multiple sclerosis and ten with spinal cord injury, and because they were unable or unwilling to do catheterization, had their urine diverted by suprapubic catheter. Seven patients, including four with spinal cord injury, underwent bladder neck closure and continent augmentation with formation of a catheterizable cutaneous stoma on the anterior abdominal wall, using right colon and right colon/ileum configurations. When ureteral reflux and obstruction are absent, the patient's bladder was used which spared the added risk of ureteral implantation and possible ureteral stricture while increasing total bladder capacity. In a select group of patients with intractable incontinence, perineal and penile skin breakdown, or urethral fistulae, bladder neck closure and urinary diversion by suprapubic catheter or continent augmentation has proven to be a reliable and effective alternative to an ileal conduit.
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Affiliation(s)
- R Chao
- University of Washington School of Medicine, Department of Urology, Seattle 98195
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Dewire DM, Owens RS, Anderson GA, Gottlieb MS, Lepor H. A comparison of the urological complications associated with long-term management of quadriplegics with and without chronic indwelling urinary catheters. J Urol 1992; 147:1069-71; discussion 1071-2. [PMID: 1552585 DOI: 10.1016/s0022-5347(17)37472-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The primary objective of this retrospective study was to compare the incidence of urological complications and renal deterioration in post-traumatic quadriplegic patients managed with or without a chronic indwelling urinary catheter. The charts of 57 consecutive patients who sustained traumatic cervical spinal cord injury between 1970 and 1980 were reviewed. All of the patients received the initial management or rehabilitation therapy at our institution. The unique features of this clinical review are that a large cohort of patients was followed for a minimum of 10 years, none of the 57 consecutive patients was lost to followup and a yearly excretory urogram provided an objective assessment of the renal units. The followup, and mechanism, level and degree of injury for the 32 patients managed with and 25 managed without a catheter were similar. Overall, the incidences of renal and bladder calculi, pyelonephritis, gross hematuria, penile/urethral erosion, urosepsis, urethral stricture, epididymitis and pyonephrosis were not significantly different in the catheterized and noncatheterized groups. The Kaplan-Meier analysis of the most recent excretory urogram demonstrated that the incidence of renal deterioration was also equivalent in the catheterized and noncatheterized groups. Our study suggests that the decision to manage quadriplegics with or without an indwelling catheter should not be based on relative risk of complications or renal deterioration. The decision to avoid an indwelling catheter in these patients should reflect patient comfort, convenience and quality of life.
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Affiliation(s)
- D M Dewire
- Department of Urology, Medical College of Wisconsin, Milwaukee
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Luangkhot R, Peng BC, Blaivas JG. Ileocecocystoplasty for the management of refractory neurogenic bladder: surgical technique and urodynamic findings. J Urol 1991; 146:1340-4. [PMID: 1942287 DOI: 10.1016/s0022-5347(17)38086-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A total of 21 incontinent adults with a neurogenic bladder who were refractory to conservative management underwent a modified technique of ileocecocystoplasty. Followup ranged from 1 to 6 years (mean 3.1 years). To ensure a wide anastomosis the augmentation was accomplished by suturing a detubularized ileocecal patch to a large posterior based bladder flap anchored to the psoas muscles. Postoperatively 20 of 21 patients were continent. The remaining woman was cured after surgical correction of sphincteric incontinence. Mean bladder capacity increased from 185 +/- 17 to 595 +/- 43 ml. (standard error). Mean maximum detrusor pressure decreased from 53 +/- 6.3 to 16 +/- 2.3 cm. water (p less than 0.0001). Followup revealed a persistently large capacity, low pressure reservoir in all patients. No patient required anticholinergic medication. None experienced acid-base imbalance, tumors in the augmented bladder or upper tract deterioration. We conclude that this technique of ileocecocystoplasty is suitable for the management of patients with a refractory neurogenic bladder.
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Affiliation(s)
- R Luangkhot
- Department of Urology, Columbia-Presbyterian Medical Center, New York
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Affiliation(s)
- F J Bramble
- Department of Urology, Bournemouth General Hospital
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