V1875 LATISSIMUS DORSI DETRUSOR MYOPLASTY IN BLADDER ACONTRACTILITY
2011-04-01

You have accessJournal of UrologyBladder Oncology & Reconstruction1 Apr 2011V1875 LATISSIMUS DORSI DETRUSOR MYOPLASTY IN BLADDER ACONTRACTILITY Georgios Gakis, Milomir Ninkovic, Gustavo Sturtz, Christian Schwentner, Karl-Dietrich Sievert, and Arnulf Stenzl Georgios GakisGeorgios Gakis Tuebingen, Germany More articles by this author , Milomir NinkovicMilomir Ninkovic Munich, Germany More articles by this author , Gustavo SturtzGustavo Sturtz Munich, Germany More articles by this author , Christian SchwentnerChristian Schwentner Tuebingen, Germany More articles by this author , Karl-Dietrich SievertKarl-Dietrich Sievert Tuebingen, Germany More articles by this author , and Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1978AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report the long-term results of the Latissimus Dorsi Detrusor Myoplasty (LDDM) procedure in patients with bladder acontractility caused by a lower motor neuron lesion. METHODS From 06/2003 until 08/2009, a total of 14 patients (mean age: 38 years, range: 17–63; 8 males, 6 females) underwent LDDM surgery. All patients required complete clean intermittent catheterization (CIC) 6 times per day (3–7) preoperatively with a mean postvoid residual urine volume (PVR) of 500 ml (250–800). Postoperative follow-up included videourodynamics after a median follow-up of 48 months (3–71 mo.). For statistical analysis, Student′s t-test method was used and p<0.05 was considered as level of significant difference. RESULTS Complete spontaneous voiding was achieved in 11 of the 14 patients (79%) after a median time of 4 months postoperatively (1.2–16.3), with a mean PVR of 25 ml (0–80). The mean maximum vesical pressure increased from 15 cm H20 (0–40) preoperatively to 52 cm H20 (30–63) postoperatively (p=0.03). In these patients, the mean maximum flow rate was 29 ml/s (15–46). In one male patient, the frequency of CIC was reduced from 6 times per day preoperatively to 3 times per day postoperatively, with a PVR of 180 ml (preop.: 500 ml) and a maximum flow rate of 10 ml/s. The maximum vesical pressure increased from 20 preoperatively to 45 cm H20 postoperatively. Two patients (1 male, 1 female) stil require CIC 4–6 times per day. In all patients, the mean bladder capacity was 470ml (360–600) and the bladder compliance >70 ml/mbar. The mean number of recurrent urinary tract infections were 10 times per year preoperatively, but ceased in all 14 patients postoperatively. No postoperative vesicoureteral reflux was observed in any patient. In addition, no muscular deficit at the donor site was reported by any patient during the long-term follow-up period. CONCLUSIONS After LDDM surgery, complete spontaneous voiding was achieved in 11 of the 14 patients (79%). Urodynamically, there was a significant increase in the maximum vesical pressure without impaired bladder compliance. Recurrent urinary tract infections ceased postoperatively in all patients. Due to these results persistent over a long-term follow-up period LDDM can be regarded as an alternative treatment option to CIC in a selective group of patients with bladder acontractility. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e752 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georgios Gakis Tuebingen, Germany More articles by this author Milomir Ninkovic Munich, Germany More articles by this author Gustavo Sturtz Munich, Germany More articles by this author Christian Schwentner Tuebingen, Germany More articles by this author Karl-Dietrich Sievert Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...