PD48-07 BLADDER CHANGES AFTER CATHETERIZABLE CHANNEL CREATION IN ADULTS WITH CEREBRAL PALSY WHO ARE IN CHRONIC URINARY RETENTION PRE-OPERATIVELY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Transitional Urology & GU Congenitalism1 Apr 2018PD48-07 BLADDER CHANGES AFTER CATHETERIZABLE CHANNEL CREATION IN ADULTS WITH CEREBRAL PALSY WHO ARE IN CHRONIC URINARY RETENTION PRE-OPERATIVELY Vikram Narayan, Ronak Gor, Jenna Katorski, and Sean Elliott Vikram NarayanVikram Narayan More articles by this author , Ronak GorRonak Gor More articles by this author , Jenna KatorskiJenna Katorski More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cerebral palsy (CP) is characterized by motor impairments as a result of injury to the brain during development. These patients are often unable to self-catheterize through their native urethra due to fine motor impairments and muscle spasticity of the limbs & pelvic floor. Chronic retention can be alleviated with catheterizable channel (CC) creation. But, we have observed that some patients with large capacity, low-pressure bladders who are in chronic urinary retention due to pseudodyssynergia pre-operatively, develop de novo neurogenic detrusor overactivity (NDO) post-operatively. We sought to better characterize this finding. METHODS We retrospectively reviewed the charts of 8 patients 17 years of age or older with a diagnosis of CP who underwent surgical creation of CC without an augmentation cystoplasty in 2011-2017. We have limited augmentation cystoplasty to those CP patients (n=11) with poor bladder compliance, refractory NDO or small bladder capacity; these are not the focus of this study. Pre-operative and post-operative UDS were reviewed, where available. Clinical data, including frequency of incontinence, use of anti-cholinergics, and need for intravesical injections of onabotulinum toxin A before and after surgery were reviewed. Descriptive summaries were tabulated. RESULTS All 8 patients had low detrusor pressures and bladder volumes of at least 250 mL (mean 528 mL) on UDS before surgery. Seven of these patients had severe CP based on the Gross Motor Function Classification System (GMFCS), with a grade of either IV or V, and one was grade III. Pre-operatively, 6 of 8 patients were in chronic retention. These patients all reported worsening incontinence post-operatively. Before surgery, 5 of 8 patients were managed with either anticholinergics or intravesical onabotulinum toxin A. Following CC creation, all patients who were previously in chronic retention required NDO management with either additional anticholinergics, intravesical onabotulinum, or mirabegron. Among those with complete UDS data (6/8 patients), 67% demonstrated lower maximum cystometric capacity post-operatively, with an average volume loss of 88.5 ±81.2 mL (SD). Median follow-up was 25 months. CONCLUSIONS Catheterizable channel creation facilitates CIC in adults with severe CP who are in chronic retention due to psuedodyssynergia. However, despite pre-operative UDS that demonstrate a large capacity, low pressure bladder, such patients often manifest diminished bladder capacities and new NDO upon initiation of CIC after surgery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e963 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Vikram Narayan More articles by this author Ronak Gor More articles by this author Jenna Katorski More articles by this author Sean Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...