1010 URODYNAMIC AND FUNCTIONAL IMAGING PROOF OF SUCCESSFUL LATISSIMUS DORSI DETRUSOR MYOPLASTY FOR ACONTRACTILE BLADDER
2010-03-23

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20101010 URODYNAMIC AND FUNCTIONAL IMAGING PROOF OF SUCCESSFUL LATISSIMUS DORSI DETRUSOR MYOPLASTY FOR ACONTRACTILE BLADDER Georgios Gakis, Milomir Ninkovic, Gustavo Sturtz, 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 , 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.2010.02.2024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Latissimus Dorsi Detrusor Myoplasty (LDDM) has been proven to be a viable option for the treatment of patients with an acontractile bladder due to traumatic, idiopathic or congenital lower motor neuropathy (Lancet, 1998, 16;351(9114):1483-5, J Urol 2003). We hereby report the urodynamic long-term results in our patient collective. METHODS From 06/2003 until 08/2009, a total of 14 patients (mean age: 38 years, range: 17-63; 8 males, 6 females) were enrolled. Preoperative evaluation included urethrocystoscopy, intravenous pyelography, electromyography of the rectus abdominis muscle and urodynamic assessment. Indications for the procedure included an acontractile bladder with no improvement for at least one year, no signs of infravesical obstruction and a life expectancy of >10 years. All patients required complete CIC 5.8 times/d (3-7) with mean postvoided residual urine volume (PVR) of 504 ml (250-800). Postoperative follow-up included videourodynamics after a follow-up of 3-71 months (mean: 46 mo.) Student′s t-test method was used with p<0.05 considered significant. RESULTS 11 of 14 patients (78.6%) gained complete control of spontaneous voiding after 1.2-16.3 months postoperatively (mean: 3.9mo.) and do not require CIC anymore. In these patients, mean bladder capacity was 470ml (360-600), bladder compliance was >70 ml/cm H20, maximum flow rate 29 ml/s (15-46) and mean PVR 25 ml (0-80). Maximum detrusor pressure (Pdet) increased from 15 cm H20 (0-40) preoperatively to 52 cm H20 (30-63) postoperatively (p=0.03). Mean episodes of recurrent urinary tract infections (UTI) were 10.3/year preoperatively, but ceased in all 11 patients after LDDM. In 1 male patient, CIC was reduced from 6 times/d preoperatively to 3 times/d postoperatively with PVR of 180ml (preop.: 500ml) and a maximum flow rate of 10 ml/s. Pdet increased from 20 to 45 cm H20 and recurrent UTIs ceased (mean preoperatively: 7.5/year). 2 patients (1 male, 1 female) stil require CIC 4-6 times/d. Both of them do not suffer from recurrent UTIs anymore. No postoperative vesicoureteral reflux was observed in any patient postoperatively. CONCLUSIONS Improvement of spontaneous voiding was achieved after LDDM in 12 of the 14 patients (85.7%). Urodynamically, there was a significant increase in detrusor pressure without impaired bladder compliance. Recurrent urinary tract infections ceased postoperatively in all patients. Due to these objective results persistent over a follow-up of up to 5.9 years LDDM must be regarded as a viable option in patients with chronic detrusor acontractility. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e392-e393 Advertisement Copyright & Permissions© 2010 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 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 ...