The role of urodynamic studies in the evaluation of patients with augmentation cystoplasties.

Abstract

To assess the role and value of videourodynamic studies (VUD) in the post-operative evaluation of 100 patients who were continent following augmentation (clam) enterocystoplasty. Fifty patients had non-neuropathic detrusor instability and 50 had neuropathic bladder dysfunction. All underwent standard dual channel medium fill cystometry and synchronous video screening before and at 6 months and 2 years after a clam ileocystoplasty. Pre-operative capacity was variable in non-neuropathic patients but post-operative capacity in this group, and both pre- and post-operative capacity in the neuropathic group, were more reproducible. Of non-neuropathic patients, 88% became stable and 83% became normally compliant, compared with only 38 and 50% respectively of neuropathic patients. More surprisingly, two of eight neuropathic patients previously stable became unstable and four of 12 of those previously normally compliant became poorly compliant. In all patients voiding spontaneously there was a tendency for capacity to increase and voiding efficiency to decrease with time. From these results, standard VUD studies contributed little to the post-operative assessment of patients with clam cystoplasties beyond that which could be obtained by ultrasonography of the bladder before and after voiding. The effect or lack of effect of augmentation cystoplasty on compliance in the neuropathic bladder suggests a neuropathic effect on bowel contractility and warrants further investigation. The meaning and significance of 'urodynamic' observations when bowel is incorporated into the bladder also needs careful investigation.