Functional Detrusor Myoplasty for Bladder Acontractility: Long-Term Results
| Autor: | Arnulf Stenzl, Gustavo Sturtz, Karl-Dietrich Sievert, Mohammad S. Rahnama'i, Milomir Ninkovic, Shailesh Raina, Gommert van Koeveringe, Georgios Gakis |
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| Přispěvatelé: | Urologie, RS: MHeNs School for Mental Health and Neuroscience |
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Detrusor muscle Nephrology medicine.medical_specialty Time Factors Lower motor neuron lesion Adolescent Urology Urinary system neurogenic Urination Risk Assessment Surgical Flaps Cohort Studies Central nervous system disease Young Adult Internal medicine Preoperative Care Humans Medicine Intermittent Urethral Catheterization Urinary Bladder Neurogenic Muscle Skeletal Retrospective Studies Postoperative Care Urinary bladder business.industry Muscle Smooth Retrospective cohort study Middle Aged Plastic Surgery Procedures Urinary Retention Clean Intermittent Catheterization medicine.disease Surgery medicine.anatomical_structure motor neuron disease treatment outcome Muscle Hypotonia Female medicine.symptom business urinary bladder Follow-Up Studies |
| Zdroj: | Journal of Urology, 185(2), 593-599. Elsevier Inc. |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | We present the long-term results of a multicenter investigation with latissimus dorsi detrusor myoplasty in patients with bladder acontractility caused by lower motor neuron lesion in whom there is no treatment alternative other than lifelong clean intermittent catheterization.From 2001 to 2008, 24 patients (median age 39 years, range 13 to 63, 16 males, 8 females) requiring complete clean intermittent catheterization 4 to 7 times daily underwent latissimus dorsi detrusor myoplasty at 4 centers worldwide. Before the procedure patients were on clean intermittent catheterization for a median of 55 months (range 17 to 195). Median followup was 46 months (range 8 to 89) and was performed by urodynamics and measurement of post-void residual urine volume. Bladder contractility index was calculated. The t test was used for statistical analysis.Of the 24 patients 17 (71%) gained complete spontaneous voiding with a mean post-void residual urine volume of 25 ml (range 0 to 100). Mean bladder contractility index increased from 20.1 ± 7.6 to 176.2 ± 25.4 (p0.001). In 3 patients (13%) the frequency of clean intermittent catheterization was reduced to 2 to 4 times daily with a mean post-void residual urine volume of 200 ml (range 150 to 250). Mean bladder contractility index was 12.0 ± 7.2 preoperatively and 68.7 ± 28.1 postoperatively (p = 0.12). Recurrent urinary tract infections (defined as the presence of clinical symptoms such as dysuria and fever, and microbiological evidence of germs) ceased in 21 of 23 patients (91%, mean preoperatively 8 per year). Four patients (17%) required clean intermittent catheterization with the same frequency as before the procedure (mean bladder contractility index preoperatively 22.5 ± 10.3 and postoperatively 26.0 ± 12.3, p = 0.83). No chronic pain at the donor site or vesicoureteral reflux was observed in any patient.The results of this multicenter analysis demonstrate that latissimus dorsi detrusor myoplasty is an effective alternative to clean intermittent catheterization in a select group of patients with neurogenic bladder acontractility. |
| Databáze: | OpenAIRE |
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