818 NOCTURNAL BLADDER EMPTYING: IT PROTECTS NOT ONLY THE UPPER TRACTS OF PATIENTS WITH HIGH PRESSURE BLADDERS, BUT ALSO IMPROVES BLADDER DYNAMICS AS WELL

Abstract

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011818 NOCTURNAL BLADDER EMPTYING: IT PROTECTS NOT ONLY THE UPPER TRACTS OF PATIENTS WITH HIGH PRESSURE BLADDERS, BUT ALSO IMPROVES BLADDER DYNAMICS AS WELL Shannon N. Nees, Andrew J. Combs, and Kenneth I. Glassberg Shannon N. NeesShannon N. Nees New York, NY More articles by this author , Andrew J. CombsAndrew J. Combs New York, NY More articles by this author , and Kenneth I. GlassbergKenneth I. Glassberg New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.637AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since first reported by Koff et al in 2002, nocturnal bladder emptying (NBE) has been increasingly recognized as beneficial in protecting the upper tracts of patients with high urine output and defective, poorly compliant bladders. While subsequent reports have documented improvement in renal function and hydronephrosis in these patients, none has documented what urodynamic changes, if any, occur in these bladders as a result of NBE. We report our experience with changes in urodynamic parameters following the addition of NBE to the patient's treatment regimen. METHODS All 15 patients treated with NBE because of persistent abnormal storage pressures despite maximum dose anticholinergic therapy were prospectively assessed urodynamically just prior to and while on NBE. Changes in VUR and hydronephrosis were also assessed. RESULTS Patient demographics and changes in bladder compliance, detrusor storage pressures and detrusor overactivity are reported in Table 1. Bladder compliance improved significantly in 12 (80%), including normalization in 8 (53%); those with HS and PUV had the greatest improvement in compliance on NBE. Detrusor overactivity resolved in 4/7 (57%). Bladder capacity was initially low (<75% expected) in 6 and high (>125%) in 5. On NBE, 9/11 (82%) had normalization of capacity. In patients with available follow up imaging, hydronephrosis improved or resolved in 44%; 2 patients with grades 4 and 5 VUR both decreased to grade 1. When NBE was discontinued by 1 patient he reverted from normal back to severe loss of compliance. CONCLUSIONS Overnight catheter drainage of the bladder not only serves to protect and improve the upper tracts as previously reported but has a direct, beneficial effect on bladder function as well. Patients with impaired detrusor compliance should not be categorized as refractory to non-surgical therapy and in need of bladder augmentation without first having NBE added to their treatment regimen as it has been our experience that the vast majority of patients show dramatic urodynamic improvement on NBE irrespective of the underlying pathology. What is not clear is how long these patients will need to be on NBE nor the long term implications of such management. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e329 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shannon N. Nees New York, NY More articles by this author Andrew J. Combs New York, NY More articles by this author Kenneth I. Glassberg New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...