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Urinary Continence Outcome After Augmentation Ileocystoplasty as a Single Surgical Procedure in Patients With Myelodysplasia

2002; Lippincott Williams & Wilkins; Volume: 168; Issue: 4 Part 2 Linguagem: Inglês

10.1016/s0022-5347(05)64428-x

1527-3792

Ricardo Medel, ADOLFO RUARTE, Marcela Herrera, Roberto Castéra, Miguel Luis Podestá,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyAugmentation/Reconstruction1 Oct 2002Urinary Continence Outcome After Augmentation Ileocystoplasty as a Single Surgical Procedure in Patients With Myelodysplasia Ricardo Medel, Adolfo C. Ruarte, Marcela Herrera, Roberto Castéra, and Miguel L. Podestá Ricardo MedelRicardo Medel , Adolfo C. RuarteAdolfo C. Ruarte , Marcela HerreraMarcela Herrera , Roberto CastéraRoberto Castéra , and Miguel L. PodestáMiguel L. Podestá View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64428-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Preoperative prediction of urinary continence in patients with myelodysplasia requiring augmentation cystoplasty is uncertain. To determine reliable factors to predict postoperative urinary continence, we retrospectively analyzed preoperative videourodynamic parameters and urinary continence outcome in a group of patients with myelodysplasia who underwent augmentation ileocystoplasty. Materials and Methods: Of 75 patients with myelodysplasia with neurogenic bladder dysfunction refractory to conservative management (anticholinergic drugs and clean intermittent catheterization) who underwent augmentation cystoplasty as a single procedure we selected 14 girls and 12 boys without previous vesicostomy drainage and with preoperative and postoperative videourodynamic studies in whom detubularized ileocystoplasty was performed. Preoperative and postoperative evaluation included physical examination, assessment of renal function, urine culture, renal and bladder ultrasound and videourodynamic studies. We analyzed on preoperative videourodynamic studies bladder outlet morphology at 20 cm. water of filling detrusor pressure, leak point pressure, cystometric bladder capacity and end filling detrusor pressure. Videourodynamic bladder outlet morphology was classified as closed bladder outlet, insinuated bladder neck, bladder neck and urethra open up to the sphincter, and bladder outlet widely open. Patients were considered continent if they were able to remain dry between catheterization without pads. For analysis patients were divided into group 1—19 with preoperative incontinence and group 2—7 without urinary incontinence. Results: After surgery 4 group 1 patients had urinary incontinence whereas all group 2 patients remained continent. Only 1 group 1 patients with leak point pressure less than 50 cm. H2O and 3 with leak point pressure greater than 50 cm. H2O were incontinent after surgery. Seven group 1 patients with cystometric bladder capacity greater than 75% and 8 with cystometric bladder capacity less than 75% of the age expected bladder capacity achieved continence. Two group 1 patients with filling detrusor pressure less than 40 cm. H2O and 2 with filling detrusor pressure greater than 40 cm. H2O continued with urinary incontinence after ileocystoplasty. Preoperative videourodynamic images of the 4 group 1 patients who remained incontinent after surgery demonstrated irrespective of the aforementioned urodynamic parameter widely open bladder outlet. Moreover, none of the postoperative continent patients had an open bladder neck and urethra on preoperative evaluation. Conclusions: According to our findings of the anatomical morphology of the bladder outlet (bladder neck/urethra) during the filling phase of videourodynamic studies at 20 cm. water filling detrusor pressure was the most reliable parameter to predict continence outcome after detubularized augmentation ileocystoplasty. References 1 : Preoperative prediction of continence after enterocystoplasty or undiversion in children with neurogenic bladder. J Urol1985; 134: 705. Link, Google Scholar 2 : Management of the bladder outlet in patients requiring enterocystoplasty. J Urol1992; 147: 38. Link, Google Scholar 3 : Augmentation cystoplasty: a critical approach. Urol Int1994; 11: 1. Google Scholar 4 : Continence in the myelodysplastic patient following enterocystoplasty. J Urol1993; 149: 1103. Link, Google Scholar 5 : Configuración de un sistema videourodinámico para uso pediátrico. Urología Panamericana1994; 6: 25. Google Scholar 6 : Standardization and definitions in lower urinary tract dysfunction in children. Br J Urol suppl1998; 81: 1. Google Scholar 7 : Prognostic value of urodynamic testing in myelodysplastic patients. J Urol1981; 126: 205. Link, Google Scholar 8 : Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder. Urology1998; 52: 672. Google Scholar 9 : Long-term results of augmentation cystoplasty. Eur Urol, suppl1998; 34: 40. Google Scholar 10 : Outcome of augmentation sigmoidocystoplasty in children with neurogenic bladder. Urol Int2000; 64: 82. Google Scholar 11 : Urethral lengthening and reimplantation for neurogenic incontinence in children. J Urol1986; 135: 533. Link, Google Scholar 12 : Modified pubovaginal sling in girls with myelodysplasia. J Urol1986; 135: 94. Link, Google Scholar From the Urology Unit, Department of Surgery, Hospital de Niños "Ricardo Gutiérrez," Associated Hospital of the University of Buenos Aires, Buenos Aires, Argentina© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBLAIVAS J, WEISS J, DESAI P, FLISSER A, STEMBER D and STAHL P (2018) LONG-TERM FOLLOWUP OF AUGMENTATION ENTEROCYSTOPLASTY AND CONTINENT DIVERSION IN PATIENTS WITH BENIGN DISEASEJournal of Urology, VOL. 173, NO. 5, (1631-1634), Online publication date: 1-May-2005. Volume 168Issue 4 Part 2October 2002Page: 1849-1852 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurinary incontinence, bladder, urodynamicsneural tube defectsMetricsAuthor Information Ricardo Medel More articles by this author Adolfo C. Ruarte More articles by this author Marcela Herrera More articles by this author Roberto Castéra More articles by this author Miguel L. 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