PURPOSE: We investigate the long-term outcome using external urethral @entity384 for high risk @entity9960 . MATERIALS AND METHODS: Since 1984 external urethral @entity384 was performed in 25 @entity1 with @entity9960 who demonstrated passive leak point pressure greater than 40 cm. @entity2507 and/or poor bladder compliance. Mean followup from the first dilation was 8.4 years. Overall 2.4 dilations were performed per @entity1 (range 1 to 8). Cystometrography, imaging study and continence status were evaluated retrospectively. RESULTS: Overall external urethral @entity384 produced durable improvements in mean leak point pressure (60.9 versus 34.4 cm. @entity2507 ), capacity (119.8 versus 233.3 ml.), initial compliance (11.5 versus 28.4 ml./cm. @entity2507 ) and terminal compliance (1.1 versus 7.7 ml./cm. @entity2507 ). Categorical analysis revealed 3 groups in terms of outcome. Group 1 consisted of 11 @entity1 (44%) who demonstrated durable improvements in urodynamic parameters as well as preservation of the upper tracts. These @entity1 demonstrated a 2-step compliance pattern on pre-dilation cystometrography, in which elevated leak point pressure was associated with excellent initial compliance. Group 2 consisted of 5 @entity1 (20%) who failed to maintain safe leak point pressure and whose upper tracts deteriorated, including 4 who eventually underwent augmentation cystoplasty. This group demonstrated a 1-step hypertonicity in which elevated leak point pressure was associated with a steep pressure increase during early filling. Group 3 consisted of 9 @entity1 (36%) who responded minimally in terms of leak point pressure reduction but whose upper tracts remained well preserved. They demonstrated a high pressure instability pattern associated with excellent baseline compliance. CONCLUSIONS: External urethral @entity384 provides an effective long-term solution for select high risk @entity9960 cases. Those who demonstrate elevated leak point pressure and poor bladder compliance at the time of external urethral @entity384 are less likely to respond, suggesting that the bladder may have already undergone irreversible changes due to high outlet resistance. @entity1 who demonstrate instability patterns are less likely to respond to external urethral @entity384 in terms of leak point pressure reduction but the upper tracts appear to be well preserved.

External urethral @entity384 for the management of high risk XXXX : 15-year experience.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity384 :: ('MESH:D002311', 'Disease') :: ['sphincter dilation'] @entity2507 :: ('CHEBI:33813', 'Chemical') :: ['H2O'] @entity9960 :: ('MESH:D008591', 'Disease') :: ['myelomeningocele']
@entity9960 :: (MESH:D008591,Disease) :: ['myelomeningocele']
