127 - Additional Therapies for Storage and Emptying Failure

Abstract

Disorders of the storage and emptying phases of micturition result in voiding dysfunction and often lead to bothersome urinary symptoms. The location of the storage or emptying failure may occur at the bladder, the bladder outlet, or a combination of both. Storage failure originating from the bladder results from poor bladder compliance, decreased capacity, detrusor overactivity, and/or altered bladder sensation. Failure of the bladder outlet to store urine is due to an incompetent closure mechanism. Emptying disorders can similarly be classified by location. At the bladder level, impaired or absent detrusor contractility leads to emptying failure. At the bladder outlet, emptying difficulties are caused by anatomic obstruction or sphincter dyssynergia/dysfunction. In previous chapters, numerous therapies for bladder storage and emptying failure have already been discussed, illustrating the complexities of voiding dysfunction management. This chapter covers additional therapies to improve bladder storage and emptying. Contemporary augmentation cystoplasty is discussed as a treatment option in adults with storage failure who have not had success with more conservative management. Options for treatment of storage failure at the outlet level include urethral injection therapy (urethral bulking agents, adjustable continence therapy, autologous stem cell injection) and functional or complete bladder outlet closure. Therapies for emptying failure include creation of catheterizable channels, catheterization (clean intermittent and indwelling), Crede and Valsalva maneuvers, promotion of reflex contractions, and stimulated myoplasty. Finally, external collecting devices and absorbent products are available for circumventing the problem.