Bladder Outlet Procedures Research Articles

Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: No Augmentation

No AccessJournal of UrologyOpposing View1 May 2013Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: No Augmentation Warren T. Snodgrass Warren T. SnodgrassWarren T. Snodgrass More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.068AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: No Augmentation." The Journal of Urology, 189(5), pp. 1628–1629 References 1 : Artificial urinary sphincter in the treatment of urinary incontinence: preoperative urodynamics do not predict the need for future bladder augmentation. J Urol1998; 160: 1093. Link, Google Scholar 2 : Is long-term bladder deterioration inevitable following successful isolated bladder outlet procedures in children with neuropathic bladder dysfunction?. J Urol2008; 179: 1991. Link, Google Scholar 3 : Use of the fascial sling for neurogenic incontinence: lessons learned. J Urol1993; 150: 683. Link, Google Scholar 4 : Biological response of bladders rendered continent by insertion of artificial sphincter. J Urol1987; 138: 1116. Link, Google Scholar 5 : A single-centre long-term outcome analysis of artificial urinary sphincter placement in children. BJU Int2002; 89: 82. Google Scholar Department of Urology, UT Southwestern Medical Center, Dallas, Texas© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 5May 2013Page: 1628-1629 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Warren T. Snodgrass More articles by this author Expand All Advertisement PDF downloadLoading ...

Bladder outlet procedures in the setting of anticoagulation therapy

To assess the safety and bleeding risk in men on chronic oral anticoagulation, including antiplatelet therapies, undergoing bladder outlet procedures for the treatment of benign prostatic hyperplasia (BPH). There are conflicting findings; however, most recent series show that when treating bladder outlet obstruction from BPH in patients on chronic anticoagulants, there is an increased risk of hemorrhagic complications for these men. There is also an increased risk of cardiovascular and cerebrovascular complications, especially when antithrombotic therapy is used for secondary prevention and is withdrawn perioperatively. Some have found bipolar electrosurgical vaporization of the prostate, laser vaporization, and enucleation of the prostate to provide superior hemostatic outcomes compared to classic monopolar transurethral resection of the prostate. Extra caution should always be given to patients on chronic anticoagulation undergoing surgical procedures, given increased risk of bleeding and cardiovascular and cerebrovascular complications. For men with BPH undergoing bladder outlet procedures, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, and vaporization of the prostate with bipolar electrosurgical instruments may result in less bleeding complications. Further prospective randomized studies are needed to elucidate which methods provide better hemostasis and lower postoperative bleeding to best manage men with BPH on chronic antithrombotic therapy, especially when the anticoagulation therapy cannot be discontinued prior to therapy.

Sequential robotic-assisted bladder diverticulectomy and radical prostatectomy. Technique and review of the literature

INTRODUCTIONAcquired bladder diverticula (BD) in men over the age of 60 are usually due to bladder outlet obstruction (BOO) secondary to prostatic enlargement. In cases of clinical significant BD with persistent symptoms or complications surgical excision should be considered. In the treatment of BD it is important to address the BOO with a bladder outlet procedure either simultaneously or in a staged fashion. PRESENTATION OF CASEWe present to the best of our knowledge, the first case of sequential robotic-assisted bladder diverticulectomy (RABD) combined with robotic-assisted radical prostatectomy (RARP) in a patient with large diverticula and malignant prostate enlargement as the cause of BOO. DISCUSSIONConcomitant open radical prostatectomy and bladder diverticulectomy series have been described, while minimal invasive procedures combining BD excision with relive of BOO especially due to benign prostatic enlargement have been reported to be safe and effective. CONCLUSIONConcomitant RABD with RARP is a safe and effective procedure with excellent oncological and functional results.

Comparison of Bladder Outlet Procedures Without Augmentation in Children With Neurogenic Incontinence

Comparison of Bladder Outlet Procedures Without Augmentation in Children With Neurogenic Incontinence

Comparison of Bladder Outlet Procedures Without Augmentation in Children With Neurogenic Incontinence

We compared continence results of the bladder neck sling vs the Leadbetter-Mitchell bladder neck procedure plus fascial sling in children with neurogenic urinary incontinence. We compared consecutive patients who received a 360-degree tight bladder neck sling to subsequent, similar patients who underwent a Leadbetter-Mitchell bladder neck procedure plus fascial sling involving a 50% reduction in bladder neck and proximal urethral diameter before a 360-degree tight sling. All patients underwent simultaneous appendicovesicostomy and none had undergone prior or simultaneous augmentation. All patients followed similar preoperative and postoperative protocols for urodynamic evaluation and anticholinergic therapy with data maintained prospectively. After surgery 46% of 35 sling cases did not require pads vs 82% of 17 Leadbetter-Mitchell cases with a sling (p = 0.02). Mean followup was 28 months in sling and 13 months in Leadbetter-Mitchell cases. Initial urodynamics done approximately 6 months postoperatively were similar in the 2 cohorts and no patient had hydronephrosis. Transient low grade reflux occurred in 2 Leadbetter-Mitchell cases, of which 1 with increased intravesical pressures early after surgery that caused trabeculation received increased medical management. Augmentation was not done in any patient except 1 previously reported on after a sling. Patients undergoing Leadbetter-Mitchell procedure plus fascial sling were significantly less likely to require pads postoperatively than those with a sling alone. Adverse bladder changes have not required augmentation to date.

Determinants of Success and Failure of Seromuscular Colocystoplasty Lined With Urothelium

Seromuscular colocystoplasty lined with urothelium is a method of bladder augmentation that avoids incorporating intestinal mucosa into the urinary tract. Others have reported a repeat augmentation rate of 23%. We analyzed the results in 20 patients who underwent the procedure, as performed by one of us (RG), at 3 institutions. After receiving institutional review board approval we retrospectively reviewed the charts of all patients operated on since 1998. Preoperative and postoperative bladder capacity at 30 cm H(2)O, expressed as the percent of expected capacity for age using the equation, bladder capacity in ml = (age +1) x 30, as well as prior, concomitant and subsequent bladder or bladder neck procedures, continence and the need for repeat augmentation were recorded. There were 20 patients, including 7 females, with a mean age at surgery of 9 years and a mean followup of 53 months. All patients had neurogenic bladder dysfunction. An artificial urinary sphincter was implanted at the time of seromuscular colocystoplasty in 10 patients, preoperatively in 6 and postoperatively in 1. A sling was used in 3 females. Patients were divided into 2 groups. The 15 group 1 patients underwent no concomitant procedure in the bladder and the 5 in group 2 underwent creation of a continent channel at seromuscular colocystoplasty. There were no failures of augmentation in group 1, in which bladder capacity increased from 60% of that expected for age to 100%. All patients were continent. Three of the 5 patients in group 2 required repeat augmentation. Seromuscular colocystoplasty lined with urothelium has proved to be an effective method to augment the bladder in patients who have an artificial urinary sphincter or who undergo simultaneous artificial urinary sphincter implantation. We do not recommend constructing a continent catheterizable channel at the time of seromuscular colocystoplasty lined with urothelium.

The Repeat Use of a Filling/Voiding Cystometrogram Does Not Alter the Urodynamic Diagnosis in Adults with Idiopathic Detrusor Overactivity

Objectives: The natural history of idiopathic detrusor overactivity (IDO) is poorly understood. The precise role of cystometry in the long-term management of IDO remains unclear. We hypothesized that repeat cystometry in adults with the OAB syndrome, in whom a urodynamic diagnosis of IDO had already been made, would not lead to a change in the urodynamic diagnosis. Patients and methods: Departmental records were reviewed retrospectively and adult patients who had undergone cystometry more than once, and received a diagnosis of IDO on their initial CMG were included. Patients who had received a urodynamic diagnosis of neurogenic DO, BOO or urodynamic SUI were excluded as were patients who had undergone a reconstructive or bladder outlet procedure following their initial CMG. The urodynamic traces were re-evaluated to determine if the urodynamic diagnosis had changed. Results: 50 patients were identified and used in the analysis. The mean interval between first and last CMG was 55.9 months. The same qualitative urodynamic diagnosis was found in 48 out of 50 cases ( p= 1.19×10−40 using Student's t-test). Conclusions: The urodynamic findings of IDO persist in the long-term, and in the absence of a significant change in symptoms, such repeat urodynamics are unlikely to yield additional information, even at intervals of several years.

Is Long-Term Bladder Deterioration Inevitable Following Successful Isolated Bladder Outlet Procedures in Children With Neuropathic Bladder Dysfunction?

Is Long-Term Bladder Deterioration Inevitable Following Successful Isolated Bladder Outlet Procedures in Children With Neuropathic Bladder Dysfunction?

Current status of bladder neck reconstruction

This paper reviews the literature over the last 3 years on bladder outlet procedures for children with urinary incontinence. The multitude of procedures and need for concomitant bladder augmentation indicates that there is no ideal surgical option for these children. The results of bladder neck slings with or without bladder augmentation have been reported in some key studies during this review period. Several modifications of the bladder wrap around sling and modifications of the Kropp-Salle procedure are described. Long-term results of bladder neck injections are highlighted. Preliminary results of complete primary repair of bladder exstrophy are compared with those of staged repair. Achieving urinary continence is difficult and continues to challenge the reconstructive surgeon. Standardized definition of dryness and further efforts to search for preoperative criteria to define the etiology of incontinence are needed to better assess outcomes.

Is Long-Term Bladder Deterioration Inevitable Following Successful Isolated Bladder Outlet Procedures in Children With Neuropathic Bladder Dysfunction?

Bladder decompensation is well described following artificial urinary sphincter implantation in neurogenic bladders. We evaluated the long-term results of various bladder outlet procedures in a subset of patients with neurogenic bladder and isolated outlet deficiency. We retrospectively reviewed the charts of 15 consecutive patients who underwent bladder outlet procedures during a 10-year period for urinary incontinence associated with neuropathic bladder dysfunction. Postoperative success was defined as a dry interval of at least 4 hours. Preoperative evaluation showed a smooth bladder in 11 patients with vesicoureteral reflux and hydronephrosis in 2. Using the minimal acceptable capacity for age, mean percent expected bladder capacity for age was 89% +/- 25%, capacity below 20 cm H(2)O was 81% and capacity below 30 cm H(2)O was 89%. Mean preoperative expected capacity for age was 60% +/- 18%. Mean postoperative followup was 11.2 years. Postoperatively, 11 patients achieved initial dryness but 9 subsequently presented with recurrent incontinence and 2 presented with upper tract deterioration. Four cases failed the initial bladder outlet procedure. Salvage procedures included augmentation cystoplasty in all 15 patients, combined with repeat bladder outlet procedure in 4 and bladder neck closure in 2. Mean time to augmentation cystoplasty was 39.6 +/- 28 months. Isolated bladder outlet procedures for neurogenic incontinence portend a poor long-term outcome, requiring augmentation cystoplasty despite the use of anticholinergic medications and strict followup. Preoperative urodynamic evaluation does not predict the need or timing from the initial bladder outlet procedure for future augmentation cystoplasty.

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

To evaluate whether the degree of preoperative bladder trabeculation in neurogenic bladder (NB) patients is a marker of significant outlet resistance. If so, severe trabeculation may obviate the need for concomitant bladder outlet procedure (BOP) during augmentation cystoplasty (AC). We retrospectively reviewed 48 incontinent patients with NB who had surgery. The patients were divided into two groups: group 1 (23 patients) had AC alone; group 2 (10) had AC with BOP. Children who had a BOP alone (15) were excluded from the study. Success was defined as a dry period of > or = 4 h. Preoperative bladder trabeculation was classified as mild or severe. Data collected included continence status, imaging and urodynamic findings. In group 1 patients before surgery, there was severe bladder trabeculation in 14 (61%), hydronephrosis in 13 (57%) and associated vesico-ureteric reflux (VUR) in 16 (70%). The mean detrusor leak-point pressure (DLPP) was 49.7 cmH2O and the bladder neck was open in nine (39%). Dryness with AC alone was achieved in 91% of group 1 patients. In group 2 patients (10 patients), there was severe bladder trabeculation in five, hydronephrosis in three, and VUR in two. The mean DLPP was 42.8 cmH2O and the bladder neck was open in eight. After surgery, eight of 10 patients achieved a dry period of 4 h. There was no significant difference between group 1 and 2 patients for age at surgery, gender, ambulatory status, hydronephrosis, degree of trabeculation, detrusor overactivity, DLPP and eventual outcome. The incidence of VUR was higher in group 1 patients (P = 0.009) and more patients in group 2 had an open bladder neck (P = 0.031). Severe bladder trabeculation in incontinent patients with NB might predict an element of intrinsic outlet resistance. In this subset of patients, dryness was achieved by AC alone without further BOP. The degree of bladder trabeculation should be considered in the surgical decision-making process for incontinent children with NB.

Do We need ureteric re-implantation during augmentation cystoplasty? a videourodinamic evaluation

Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children with high pressure low compliant bladders and vesicoureteral reflux (VUR) who underwent augmentation cystoplasty without antireflux surgery. We hypothesized that not always bad preoperative bladder dynamics are to blame for the associated VUR. VUR persists despite successful augmentation in some. We tried to find objective urodynamic criteria where antireflux surgery might potentially be necessary to avoid persisting VUR. Material and methods 19 meningomyelocele patients with hypocompliant overactive bladder and associated high gradeVUR with a mean age of 11.4 years(5-21) underwent ileocystoplasty alone. Bladder outlet procedures, previous operation and persitent night-time drainage were excluded. Bladders were assessed preoperatively and sixth months postoperatively by multicycleVUDs Results VUR persisted in 9 patients despite a low pressure, compliant bladder being achieved. In these, VUR started at lower volumes with a mean of 29.6ml;(19-52ml) and lower pressures with a mean of 14.6cm-H20(9.6-25). Whereas in patients with no persistent VUR, it started at higher pressures (mean 49 cm-H20)(33-68). When preoperative VUD findings were retrospectively analysed, VUR started at lower volumes (mean14.8ml; 8-33) and intravesical pressures (mean7.8 cm-H20; 4 -17) in these 9 patients when compared to cases with resolved VUR Conclusions Preoperative VUD findings might be a predictor for resolution of VUR after augmentation. If VUR starts at low pressures, it is very likely to persist after augmentation. In these patients VUR should be corrected during augmentation. Further urodynamic cut off values for reimplantation would be useful to predict the outcome and thus the approach to VUR during augmentation.

The Outcome of Bladder Neck Closure in Children With Severe Urinary Incontinence

We evaluated the outcome of children who underwent bladder neck closure for the management of severe urinary incontinence. Bladder neck closure was performed in 12 patients with bladder exstrophy, 4 with myelomeningocele and 4 with urogenital sinus anomalies for severe urinary incontinence that persisted after multiple failed bladder outlet procedures. The effectiveness of bladder neck closure and the need for subsequent surgeries were ascertained. Mean followup was 5.4 years (range 1 to 12). At 3 months after surgery 40% of the patients were completely dry, 20% had leakage via the stoma and 40% had a urethral fistula. After additional surgeries 85% of the patients were completely continent 2 years following bladder neck closure (15% declined further surgeries or had an ileal conduit). Of the 15 patients with followup longer than 3 years only 40% remained completely dry, and leakage via the stoma developed in 47% after being dry for 1 year. Repeat urodynamic studies did not show any adverse changes in bladder dynamics in the incontinent patients. Stomal stenosis occurred in 30% of the patients and bladder stones developed in 40%. None of the patients had hydronephrosis or bladder perforation. The early complication of fistula formation and the late development of leakage via the stoma appear to be related in part to compliance with intermittent catheterization. Bladder neck closure is an effective method of achieving urinary continence in children in whom other bladder outlet surgery has failed. However, its success is dependent in part upon compliance with intermittent catheterization. Finally children who have undergone bladder neck closure are at an increased risk for stomal stenosis and bladder stones.

Advantages of rectus fascial slings for urinary incontinence in children with neuropathic bladders.

Many surgical procedures to improve outlet resistance in children with neuropathic bladders are obstructive and increase the detrusor leak point pressure. In contrast, fascial slings are designed to achieve continence by increasing the Valsalva or stress leak point pressure without altering the detrusor leak point pressure. We evaluate the effectiveness of fascial slings in achieving continence in pediatric patients with neuropathic bladder. From October 1994 until February 1999, 10 females and 8 males with neuropathic bladder secondary to myelodysplasia or traumatic spinal cord injury underwent fascial sling procedures. Mean patient age was 14 years (range 8 to 18) and all were incontinent despite aggressive medical management. Urodynamic evaluation was performed preoperatively and postoperatively. Specific urodynamic measurements included detrusor leak point pressure, stress leak point pressure and detrusor compliance. Compliance was only compared in the 12 nonaugmented cases. With a mean followup of 21.2 months (range 6 to 57), preoperative and postoperative urodynamics revealed little change in mean detrusor leak point pressure (23.2 versus 23.22 cm. H2O) but a substantial increase in mean stress leak point pressure (41.6 versus 64.5 cm. H2O). Mean compliance was unchanged in the nonaugmented group (22.00 versus 26.78 ml/cm. H2O). Four patients (22.22%) remained wet after surgery, of whom 2 were successfully treated with a repeat sling procedure and 1 with collagen injection for an overall continence rate of 94.44%. Fascial slings can be effectively used in pediatric patients for neuropathic incontinence. Furthermore, stress urinary incontinence is corrected by increasing the Valsalva or stress leak point pressure with preservation of the detrusor leak point pressure. Preservation of detrusor leak point pressure is particularly advantageous because other forms of bladder outlet procedures achieve continence at the expense of increasing detrusor pressures, thus placing the upper tracts at risk for damage.

ADVANTAGES OF RECTUS FASCIAL SLINGS FOR URINARY INCONTINENCE IN CHILDREN WITH NEUROPATHIC BLADDERS

Many surgical procedures to improve outlet resistance in children with neuropathic bladders are obstructive and increase the detrusor leak point pressure. In contrast, fascial slings are designed to achieve continence by increasing the Valsalva or stress leak point pressure without altering the detrusor leak point pressure. We evaluate the effectiveness of fascial slings in achieving continence in pediatric patients with neuropathic bladder. From October 1994 until February 1999, 10 females and 8 males with neuropathic bladder secondary to myelodysplasia or traumatic spinal cord injury underwent fascial sling procedures. Mean patient age was 14 years (range 8 to 18) and all were incontinent despite aggressive medical management. Urodynamic evaluation was performed preoperatively and postoperatively. Specific urodynamic measurements included detrusor leak point pressure, stress leak point pressure and detrusor compliance. Compliance was only compared in the 12 nonaugmented cases. With a mean followup of 21.2 months (range 6 to 57), preoperative and postoperative urodynamics revealed little change in mean detrusor leak point pressure (23.2 versus 23.22 cm. H2O) but a substantial increase in mean stress leak point pressure (41.6 versus 64.5 cm. H2O). Mean compliance was unchanged in the nonaugmented group (22.00 versus 26.78 ml/cm. H2O). Four patients (22.22%) remained wet after surgery, of whom 2 were successfully treated with a repeat sling procedure and 1 with collagen injection for an overall continence rate of 94.44%. Fascial slings can be effectively used in pediatric patients for neuropathic incontinence. Furthermore, stress urinary incontinence is corrected by increasing the Valsalva or stress leak point pressure with preservation of the detrusor leak point pressure. Preservation of detrusor leak point pressure is particularly advantageous because other forms of bladder outlet procedures achieve continence at the expense of increasing detrusor pressures, thus placing the upper tracts at risk for damage.

Incomplete bladder duplication

British Journal of UrologyVolume 75, Issue 1 p. 106-107 Incomplete bladder duplication A.A. Shokeir, A.A. Shokeir Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt A.A. Shokeir, MD, Lecturer.Search for more papers by this authorA. Ashamallah, A. Ashamallah Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt I. Ashamallah, MD, Professor.Search for more papers by this authorH. Abol-Enein, H. Abol-Enein Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt H. Abol-Enein, MD, Lecturer.Search for more papers by this authorM.A. Shokeir, Corresponding Author M.A. Shokeir *Paedlatric Department, Mansoura University, Mansoura, Egypt M.A. Shokeir, MD, Lecturer.**Urology and Nephrology Centre, Masoura University, Mansoura. Egypt.Search for more papers by this authorA.H. Taqi, A.H. Taqi Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt A. Taqi, Research Fellow.Search for more papers by this author A.A. Shokeir, A.A. Shokeir Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt A.A. Shokeir, MD, Lecturer.Search for more papers by this authorA. Ashamallah, A. Ashamallah Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt I. Ashamallah, MD, Professor.Search for more papers by this authorH. Abol-Enein, H. Abol-Enein Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt H. Abol-Enein, MD, Lecturer.Search for more papers by this authorM.A. Shokeir, Corresponding Author M.A. Shokeir *Paedlatric Department, Mansoura University, Mansoura, Egypt M.A. Shokeir, MD, Lecturer.**Urology and Nephrology Centre, Masoura University, Mansoura. Egypt.Search for more papers by this authorA.H. Taqi, A.H. Taqi Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt A. Taqi, Research Fellow.Search for more papers by this author First published: January 1995 https://doi.org/10.1111/j.1464-410X.1995.tb07251.xCitations: 3 AboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume75, Issue1January 1995Pages 106-107 RelatedInformation RecommendedAssessment of urodynamic and detrusor contractility variables in patients with overactive bladder syndrome treated with botulinum toxin‐A: is incomplete bladder emptying predictable?Arun Sahai, Philippa Sangster, Vinay Kalsi, Mohammad S. Khan, Clare J. Fowler, Prokar Dasgupta, BJU InternationalIs the ultrasound‐estimated bladder weight a reliable method for evaluating bladder outlet obstruction?Fernando G. Almeida, Danielo G. Freitas, Homero Bruschini, BJU InternationalBladder autoaugmentation in myelodysplastic childrenL. Skobejko-Wlodarska, K. Strulak, P. Nachulewicz, C. Szymkiewicz, British Journal of UrologyNeuroanatomical changes in the rat bladder after bladder outlet obstruction Sutherland, Baskin, Kogan, Cunha, British Journal of UrologySevere bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladderAntoine E. Khoury, Sumit Dave, Maria Helena Peralta-Del Valle, Luis H.P. Braga, Armando J. Lorenzo, Darius Bägli, BJU International