MP17-03 THE MAXIMUM DETRUSOR PRESSURE AS A PREDICTIVE FACTOR AFTER INCONTINENTATION PROCEDURES FOR SURGICAL MANAGEMENT OF DETRUSOR-SPHINCTER DYSSYNERGIA

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction1 Apr 2016MP17-03 THE MAXIMUM DETRUSOR PRESSURE AS A PREDICTIVE FACTOR AFTER INCONTINENTATION PROCEDURES FOR SURGICAL MANAGEMENT OF DETRUSOR-SPHINCTER DYSSYNERGIA Alexandre Hourié, François-Xavier Nouhaud, Maximilien Baron, John-David Rebibo, Jean-Nicolas Cornu, and Philippe Grise Alexandre HouriéAlexandre Hourié More articles by this author , François-Xavier NouhaudFrançois-Xavier Nouhaud More articles by this author , Maximilien BaronMaximilien Baron More articles by this author , John-David RebiboJohn-David Rebibo More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , and Philippe GrisePhilippe Grise More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2671AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor-sphincter dyssynergia (DSD) is the most common cause of functional bladder outlet obstruction in patients with neurogenic bladder. In patients who cannot use clean intermittent self-catheterization (CISC), incontinentation either by placement of sphincteric stent prosthesis or sphincterotomy has been described as an effective treatment. However, no clear predictive factor of success or failure has been clearly identified. Our goal was to evaluate the impact of the pre-operative maximum detrusor pressure (MDP) on efficacy outcomes after incontinentation procedures for DSD in male patients with neurogenic bladder. METHODS A retrospective study was performed in 41 male patients treated between 2006 and 2013 in a tertiary reference center. All patients had a neurogenic bladder with voiding dysfunction, and DSD confirmed by urodynamic studies (including filling cystometry, MDP measurement, and uroflowmetry). All patients were unable or secondary failed to practice CISC. Patients underwent sphincterotomy or placement of a sphincteric stent prosthesis, and were then followed every 6 months. Success was defined as a post-void residual volume < 150 ml. Influence of MDP on treatment efficacy was evaluated through a Mann-Whitney U-Test. All statistical analyses were done with XLStat for Windows. RESULTS Mean patient age was 39 years. Underlying neurological diseases causing DSD were spinal cord injury, multiple sclerosis, or congenital syndromes. Twenty- six patients had a sphincteric stent placement (Memocath™, Bard, Covington, USA) and 15 had endoscopic sphincterotomy. Treatment was successful in 31 patients (76%). Patients with successful outcomes had a significantly higher mean preoperative MDP (59.6 vs. 29.7 cmH2O; p=0.002). Patients with MDP over the threshold of 40 cmH2O had a 90 % success rate. These differences were maintained at 6 months, MDP being higher in the success group than in the failure group (59.5 vs. 39.8 cm H20 respectively, p=0.008). The technique used (stent placement or sphincterotomy) had no impact on immediate or 6-month success rates. CONCLUSIONS Our results suggested that MDP is associated with treatment success rate after surgical management of DSD of neurogenic origin by sphincteric stent placement or sphincterotomy. A threshold of 40cm H20 is associated with high positive predictive value. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e185 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alexandre Hourié More articles by this author François-Xavier Nouhaud More articles by this author Maximilien Baron More articles by this author John-David Rebibo More articles by this author Jean-Nicolas Cornu More articles by this author Philippe Grise More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...