External Sphincter Dyssynergia Research Articles

Bladder outlet obstruction in women: Scope of the problem and differential diagnosis

AbstractIntroductionThe prevalence, formal definition, and diagnostic criteria of bladder outlet obstruction in owmen have not been clearly defined.MethodsThis is a literature review of the definition of BOO in women, its prevalence, as well as its differential diagnosis.ResultsThe main causes of BOO in women are divided into functional and anatomic conditions. Functional etiologies include detrusor external sphincter dyssynergia, dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction. Anatomic causes can be further divided into extrinsinc and intrinsic conditions. Intrinsic etiologies include urethral stricture and urethral diverticula, whereas extrinsic causes comprise pelvic organ prolapse, post anti‐incontinence surgery, and Skene's gland cyst or abscess.ConclusionsThere are multiple etiologies to BOO in women, and this condition is most probably underdiagnosed, owing to a lack of consensus for a standard definition.

Urologic manifestations of hypotonia, ataxia, and delayed development syndrome (HADDS), a rare neurodevelopmental disorder

Early B-cell factor 3 (EBF3) is a transcription factor involved in neuronal differentiation and maturation. Pathogenic variants are associated with hypotonia, ataxia, and delayed development syndrome (HADDS) (MIM#617330). Urologic manifestations are common and may have implications regarding long term renal function. To review all known patients with pathogenic variants of the EBF3 gene resulting in HADDS with urologic manifestations. We hypothesize a high rate of bladder dysfunction secondary to the EBF3 variant's impact on relaxation of the urinary sphincter leading to detrusor sphincter dyssynergia (DSD). The PubMed database was queried for publications of the EBF3 mutation between January 2017 and January 2023. Search terms were "EBF3 mutation OR HADDS AND urology OR phenotype". Retrospective analysis of HADDS patients cared for in our institution was performed. Demographic and clinical information was collected. We identified 52 patients (33F:19M) through literature (28F:18M) and retrospective review (5F:1M). There was a high prevalence of genitourinary physical exam abnormalities, history of urinary tract infection, vesicoureteral reflux (VUR), and diagnosis of neurogenic bladder. Within the literature review cohort, 67% had a urologic diagnosis. Females were disproportionately affected with urologic manifestations. In our cohort, four of six children were diagnosed with VUR and severe voiding dysfunction consistent with neurogenic bladder (67%). These children were managed with a vesicostomy. Five children had bowel dysfunction requiring therapy. Urodynamics suggested a high prevalence of external sphincter dyssynergia. Less severe forms of DSD were felt to be implicated in the abnormal voiding parameters in children who presented later in life based on non-invasive flow studies. There is significant variability in the phenotypic presentation of patients with HADDS. While EBF3 plays a clear role in neurodevelopment, it also impacts muscle development and may impact muscle relaxation. The location of the genetic variant may impact the degree of DSD, with more severe forms leading to earlier presentations. Initial work-up should include a renal ultrasound (RUS) and post void residual (PVR). Consideration can be given to obtaining a VCUG, DMSA scan or urodynamic studies. Yearly screening should be pursued with an RUS and PVR in those with an initial unremarkable work-up given the variable timing and severity of presentation. Urologic manifestations of HADDS include high rates of bladder dysfunction secondary to DSD, vesicoureteral reflux, urinary tract infection, and cryptorchidism. These patients are at risk of renal deterioration if urinary abnormalities are not properly diagnosed and managed.

Biomechanical study of the male lower urinary tract: Simulation of internal and external sphincters dyssynergia

Urethral sphincter dysfunction is an important cause of stress urinary incontinence (SUI). The most effective treatment is the insertion of an artificial urethral sphincter (AUS), which relies to a large extent on the surgeon’s experience. However, there is no quantitative standard for cuff tightness, resulting in frequent postoperative complications. This study aimed to investigate the effect of internal and external sphincter dyssynergia on urodynamic parameters in the lower urinary tract. A geometric model of male lower urinary tract tissue was constructed from collodion slices, accounting for the active behavior of the internal and external sphincters. Normal and dyssynergic internal and external sphincters (active sphincter behavior was individually injured by 25%, 50%, 75%, or 100%) were simulated with fluid–structure interactions and changes in urethral stress, displacement, and urine flow rate were detected. We found that when the internal sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the internal sphincter decreased by 8.3%, 15.6%, 24.3%, and 35.7%, respectively. Additionally, when the external sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the external sphincter was reduced by 13.3%, 24.3%, 38.6%, and 46.6%, respectively. Internal sphincter injury primarily affects positions near the internal sphincter and prostate, while external sphincter injury affects the area between the prostate and urethral outlet. These data could facilitate the standardized evaluation of internal and external sphincter dysfunction and lead to novel methods of preoperative assessment for AUS surgery.

Conforming an Extracorporeal Lithotripter System for Video Urodynamic Studies

Objectives: This study aimed to evaluate the efficiency using existing fluoroscopic unit and lithotripter table of an extracorporeal lithotripter system for video urodynamic studies (VUDS) to determine anatomical abnormalities in patients with neurogenic lower urinary tract dysfunction (NLUTD).
 Methods: The extracorporeal lithotripsy system was adapted to obtain optimum fluoroscopic view according to body shape and observed organs of patients. We reviewed the VUDS data of 25 patients with NLUTD.
 Results: “Christmas tree bladder” (CTB) was found in 5 (20%) patients. Vesicoureteral reflux (VUR) and external detrusor sphincter dyssynergia (DESD) were detected in 3 (12%) and 4 (16%) patients, respectively. Four (16%) patients with normal coordination between detrusor contraction and external sphincter relaxation were proven by VUDS. CTB, VUR, or DESD was not observed in 10 (40%) patients with flaccid bladder. Hematuria, urinary tract infection, or autonomic dysreflexia did not occur in any of the patients.
 Conclusions: VUDS can discern anatomical abnormalities of the urinary tract, and patients in undeveloped areas of the world who have NLUTD can have easier access to VUDS because of the decreasing capital cost of VUDS.

Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury.

Urodynamics is the gold standard for evaluating the function of neurogenic bladder after spinal cord injury (SCI), but there are few studies on urodynamics in patients with complete and incomplete suprasacral SCI in different periods.There is a lack of sufficient evidence for the timing of the first urodynamic examination. The urodynamic results of 101 patients with complete and incomplete suprasacral SCI at 0-30, 31-60, 61-90, and 91-365 days after injury were included. Urodynamic parameters were compared between 0-90 and 91-365 days, including detrusor overactivity (DO), bladder compliance (BC), bladder-filling sensation, maximum cystometric capacity (MCC), detrusor external sphincter dyssynergia (DESD), maximum urinary flow rate (Qmax), detrusor pressure at a maximum urinary flow rate (PdetQmax). There were 45 patients with complete SCI and 56 with incomplete SCI. With the course's prolongation, the proportion of DO increased gradually in patients with complete and incomplete injury within 90 days, while the MCC gradually decreased. The bladder-filling sensation of patients with complete SCI is mostly absent. Significant differences were found between 0-90 and 91-365 days in terms of DO, DESD, MCC, Qmax, and PdetQmax incomplete SCI, and DESD in incomplete SCI, and between complete and incomplete SCI in terms of DO, bladder filling sensation, MCC, Qmax, PdetQmax at 0-90 days after injury, and bladder filling sensation at 91-365 days after injury. Urodynamic examination should be conducted as soon as possible after injury in patients with incomplete suprasacral SCI, while for those with complete injury, the urodynamic examination can be initiated following clinical symptoms within 90 days after injury.

Combined Detrusor and External Urethral Sphincter BTX-A Injections for Detrusor Overactivity and Detrusor External Sphincter Dyssynergia Secondary to Spinal Cord Injury

Objective: To evaluate the efficacy and safety of Combined detrusor and external urethral sphincter BTX-A injections for detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. Study Design: Prospective study. Methods: The study was carried out in 18 SCI patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) receiving Combined detrusor and external urethral sphincter BTX-A injections treatment. Contain 200 U botulinum toxin intradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD (PdetmaxDO-DESD), volume at first DO and DESD (VDO-DESD), maximum urethral closure pressure (MUCP), and Incontinence-Specific Quality-of-Life Instrument (I-QoL). Adverse events were recorded. Results: All patients experienced a significant mean reduction in PdetmaxDO-DESD (50.75%), maximum urethral closure pressure (26.34%) and a significant mean increase in VDO-DESD (63.00%) 12-weeks post-injection. Significant (p < 0.001) improvement in mean Incontinence-Specific Quality-of-Life Instrument was also found. No obvious adverse event and toxic effect was observed. Conclusion: Combined detrusor and external urethral sphincter BTX-A injections is a good choice for patients with DO and DESD secondary to spinal cord injury. It could not only protect the upper urinary tract but also improve quality of life.

Low Interrater Reliability of Videourodynamic Diagnosis of Detrusor External Sphincter Dyssynergia.

Complex bladder dysfunction requires urodynamic testing, often under fluoroscopy termed videourodynamic study (VUDS), to assist the diagnosis and management. Videourodynamic study is an objective tool with high interrater reliability (IRR) for identifying detrusor overactivity. However, IRR has not been validated with disorders associated with neurogenic bladder (NGB). We aim to investigate the IRR of VUDS to diagnose detrusor external sphincter dyssynergia (DESD) among NGB patients and hypothesize a high IRR to DESD diagnosis on VUDS. Videourodynamics tracings with fluoroscopic images were rated either positive or negative for evidence of DESD by 4 raters (2 neurourologists, neurourology fellow, and urology postgraduate year 2 resident), in patients who underwent VUDS from 2013 to 2017. The study population had known NGB without previous bladder reconstruction. The IRR was determined using percent agreement and κ values. The experts had a percent agreement of 82.1% (κ = 0.26). Expert 1 and expert 2 had a percent agreement of 63.6% (κ = 0.1497) and 68.9% (κ = 0.2967), respectively, when compared with the fellow. Sensitivity and specificity ranged from 28% to 75% and 64% to 93%, respectively. The negative predictive values ranged from 90% to 95%. The IRR to diagnose DESD on VUDS was much lower than expected, even among experts, and was likely multifactorial and partially owing to lack of clinical context and lack of standardized VUDS interpretation of the electromyogram. A high negative predictive value was found among all participants. Further research is needed to evaluate factors contributing to the low reproducibility of DESD diagnosis on VUDS.

Urodynamic Abnormalities in Patients with Relapsing Remitting Multiple Sclerosis

Background: Multiple sclerosis (MS) is a disease with wide variability in clinical presentation. Bladder dysfunctions are very common in MS patients. Early detection of bladder abnormalities is important to improve the outcome in MS patients. Objectives: The aim of this study is to evaluate the urodynamic detected bladder dysfunctions in relapsing remitting MS patients with mild or without lower urinary tract symptoms. Methods: This is a prospective study for 32 patients with relapsing remitting Multiple Sclerosis from January 2017 to June 2018. We included patients with mild or without lower urinary tract symptoms (LUTS) who had mild to moderate disability. Urodynamic studies were performed for all patients. Results: Urodynamic abnormalities were detected in 22 patients (68.75%). Detrusor overactivity (DO) was present alone in 8 patients (25%); DO combined with detrusor external sphincter dyssynergia in 8 patients (25%); DO with low compliant bladder and impaired contractility in another 4 patients (13%) while DO with low complaint bladder in 2 patients (6%). Bladder dysfunction was correlated to high disability score; longer duration of illness; frequent relapses and the presence of LUTS. Conclusion: Urodynamic abnormalities were found in 68.75% of our patients. This highlights the importance of urodynamic studies in the early evaluation of relapsing remitting Multiple Sclerosis.

Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. Cross sectional survey. The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2 O (OR = 3.879). According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc.

Urologic applications of botulinum toxin.

The neuromuscular blocker botulinum toxin has a wide variety of medical applications, including overactive bladder and neurogenic detrusor overactivity in patients in whom drug therapy fails or is not well tolerated. Botulinum toxin therapy for these conditions has been shown to be safe and effective in several large multicenter randomized controlled trials. Off-label uses in urology include detrusor external sphincter dyssynergia and pelvic pain syndromes.

Risk factors of urethral diverticula in male patients with spinal cord injury.

A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments. To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated. Toledo, Spain. Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol. The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra. According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.

Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Trocar Catheter Transurethral Botulinum Toxin A Injection in Men With Spinal Cord Injury

ObjectiveTo evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI). DesignDescriptive study. SettingHospital rehabilitation department. ParticipantsPatients (N=15; mean age, 40.5y; range, 22–64y) with suprasacral SCI with confirmed DESD determined by urodynamic study. InterventionsA single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection. Main Outcome MeasuresMaximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate. ResultsAfter BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure (P<.05) and detrusor leak point pressure after treatment (P<.05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment (P<.05). ConclusionsTransrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the EUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection.

No. 55 Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Catheter Trocar Botulinum Toxin A Injection in Male Patients with Spinal Cord Injury

PM&RVolume 6, Issue 8S2 p. S93-S94 Oral Presentation No. 55 Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Catheter Trocar Botulinum Toxin A Injection in Male Patients with Spinal Cord Injury Wei Xin Yang, Wei Xin YangSearch for more papers by this authorHong Jun Zhu, Hong Jun ZhuSearch for more papers by this authorDa Wei Zhang, Da Wei ZhangSearch for more papers by this authorWei Guo Chen, Wei Guo ChenSearch for more papers by this author Wei Xin Yang, Wei Xin YangSearch for more papers by this authorHong Jun Zhu, Hong Jun ZhuSearch for more papers by this authorDa Wei Zhang, Da Wei ZhangSearch for more papers by this authorWei Guo Chen, Wei Guo ChenSearch for more papers by this author First published: 18 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.323Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare 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 Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume6, Issue8S28th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM)August 2014Pages S93-S94 RelatedInformation

Vejiga neurogénica no neurogénica (síndrome de Hinman). Dos tratamientos diferentes a un mismo problema

Nonneurogenic neurogenic bladder, also known as Hinman syndrome, is a rare entity characterized by nonneurogenic urinary bladder dysfunction. It is a diagnosis of exclusion and is assigned to those children that present with clinical, radiologic, and urodynamic characteristics of a neurogenic bladder with external sphincter dyssynergia, but with no evidence of any neurologic alteration. In 1973, Hinman and Baumann were the first to report a case series of 14 children with nonneurogenic neurogenic bladder and treated these patients with bladder reeducation and hypnosis. Bladder re-training and medical treatment have been recognized as effective management. However, when there is established damage to the upper urinary system, or risk thereof, surgery is preferred over conservative treatment. Due to the low incidence of the disease, there is still no consensus as to the most adequate treatment or management, making it essential to describe every case possible in order to gain the necessary knowledge for providing the best treatment for patients with this syndrome.We present the cases of two boys with Hinman syndrome, 10 and 12 years old, for whom conservative treatment was not sufficient given that they already presented with upper urinary system damage. They underwent successful surgical treatment that was individualized for each case, resulting in 2 different solutions for the same problem.

Quality Assurance and Patient Safety in the Gastroenterology Unit

Neural control of the pelvic organs is one of the most intriguing in the body involving both autonomic and somatic components organized in the thoraco-lumbar (sympathetic), lumbosacral (somatic), and sacral (parasympathetic) spinal cord. Loss of supraspinal descending control and plasticity-mediated alterations at the level of the spinal cord, result in loss of voluntary control and in abnormal functioning of these systems including the development of dyssynergia and spasticity. Originally DSD has been used for Bladder external urethral sphincter discoordination, also known as detrusor external sphincter dyssynergia. The ICS standard terminology agreed in 1998, “ DSD is a consequence of a neurological pathology such as spinal cord injury or multiple sclerosis that disrupts central nervous system regulation of the Micturition (urination) reflex, resulting in discoordination of the detrusor muscles of the bladder and the external urethral sphincter muscles [1]”. Since anal external sphincter and external urethra sphincter share essentially the same innervations [2], these patients also have Ano-rectal and Pelvic floor dyssenergia (PVD) following spinal cord lesions. The terms Detrusor Sphincter Dyssenergia (DSD) and dyssenergic response indicated uncoordinated external urethral sphincter (EUS) on attempted voiding in complete and incomplete spinal cord injury lesions [1]. In normal persons attempted voiding leads to the relaxation of the external urethral sphincter; however in any supraconal spinal cord lesion below Pontine Micturition Center, there is a failure of relaxation of the urethral sphincter which leads to retention of urine. In incomplete lesions there may be some intermittent relaxation on attempted voiding which was referred as dyssenergic response [3]. This can be demonstrated on simultaneous recording of bladder pressures [Manometry] and a periurethral EMG studies.

Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients

To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. Among them, there were detrusor overactivity (n = 82, 72.57%), detrusor areflexia (n = 31, 27.43%), detrusor external sphincter dyssynergia (n = 71, 62.83%), low-compliance (n = 59, 52.21%), reflux (n = 6, 5.31%) and ultrasonic uronephrosis (n = 12, 10.62%). According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus (n = 2) and urinary infection (n = 7).No special complication occurred. The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

Acute Spinal Cord Injury—Do Ambulatory Patients Need Urodynamic Investigations?

We compared the urodynamic parameters of ambulatory vs nonambulatory acute spinal cord injured patients. A total of 27 women and 33 men (mean age 58 years) with neurogenic lower urinary tract dysfunction due to acute spinal cord injury (duration of injury less than 40 days) were prospectively evaluated. The patients were dichotomized according to the mobility for moderate distances subscale of the SCIM (Spinal Cord Independence Measure) version III into ambulatory (score of 3 or greater) and nonambulatory (score less than 3). Videourodynamic parameters including maximum detrusor pressure during the storage phase, bladder compliance, detrusor overactivity, detrusor external sphincter dyssynergia and vesicoureterorenal reflux were compared between the groups. Of the 60 patients with acute spinal cord injury 17 were ambulatory and 43 were nonambulatory. Mean ± SD duration of injury at urodynamic investigation was 30 ± 8 days. The lesion level was cervical in 14 patients, thoracic in 28 and lumbar/sacral in 18. Comparing unfavorable urodynamic parameters, no significant differences were found between ambulatory vs nonambulatory patients in terms of a high pressure system during the storage phase (29% vs 33%, p = 0.81), a low compliance bladder (12% vs 7%, p = 0.54), detrusor overactivity (24% vs 47%, p = 0.1), detrusor external sphincter dyssynergia (18% vs 21%, p = 0.77) and vesicoureterorenal reflux (0% vs 5%, p = 0.36). Ambulatory and nonambulatory patients with acute spinal cord injury have a similar risk of unfavorable urodynamic measures. Thus, we strongly recommend the same neurourological assessment including urodynamic investigations in all acute spinal cord injury patients independent of the ability to walk.

External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?

BackgroundCombined pelvic floor electromyography (EMG) and videocystourethrography (VCUG) during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD). Theoretically, external urethral sphincter pressure (EUSP) measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD.Patients & MethodsA consecutive series of 72 patients (36 women, 36 men) with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test) versus combined pelvic floor EMG and VCUG (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative.ResultsUsing EUSP measurement (index test) and combined pelvic floor EMG and VCUR (reference standard), DESD was diagnosed in 10 (14%) and in 41 (57%) patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%–25%), specificity of 87% (95% CI 76%–98%), positive predictive value of 60% (95% CI 30%–90%), and negative predictive value of 56% (95% CI 44%–68%) for the diagnosis of DESD.ConclusionsFor diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR.

1664 IMPACT OF DETRUSOR SPHINCTER DYSSYNERGIA ON CLINICAL AND URODYNAMIC PARAMETERS OF PATIENTS WITH NEUROMYELITIS OPTICA

INTRODUCTION AND OBJECTIVES: Detrusor external sphincter dyssynergia (DESD) is a cause of elevated vesical pressures and may increase the risk of renal deterioration. Neuromyelitis Optica (NMO) is a newly defined demyelinating autoimmune disease of the central nervous system that affects the spinal cord and was formerly considered a severe form of multiple sclerosis. The purpose of this study was to evaluate the impact of DESD in patients with NMO. METHODS: We prospectively evaluated 30 patients (23 women and 7 men) with a mean age of 41.1 13.5 years (range 13 to 70) and mean duration of disease of 33.8 30.8 months (range 3 to 135). All patients had an established diagnosis of NMO based on stringent criteria and were invited to participate irrespective of the presence of LUTS. Urinary symptoms were evaluated with the International Prostatic Symptom Score (IPSS) and neurological impairment with the Expanded Disability Status Scale (EDSS). All patients underwent videourodynamics and upper urinary tract sonography. We compared clinical and urodynamic parameters based on the presence of DESD. RESULTS: A total of 18 (60.0%) patients had DESD. Compared to patients without DESD (Table), patients with sphincteric dyssynergia had worse urinary symptoms and neurological impairment but no differences in terms of age and disease duration. In terms of urodynamic parameters, those with DESD had greater detrusor pressure at maximal flow (PdetQmax), decreased voided volume and increased postvoid residual volume. Other parameters were not different between the two groups. Upper urinary tract changes were not found in any patient. CONCLUSIONS: DESD is present in most patients with NMO and is associated with worse neurological impairment and urinary symptoms. Despite the increased detrusor pressures observed in patients with DESD, no patients had upper urinary tract damage. Ongoing evaluation of NMO patients will be important to identify those with this newly defined neurological condition who are at risk of upper urinary tract damage.

1169 A UNIQUE MODIFICATION TO AUGMENTATION CYSTOPLASTY WITH CATHETERIZABLE STOMA FOR NEUROGENIC PATIENTS TECHNIQUE AND LONG TERM RESULTS

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121169 A UNIQUE MODIFICATION TO AUGMENTATION CYSTOPLASTY WITH CATHETERIZABLE STOMA FOR NEUROGENIC PATIENTS TECHNIQUE AND LONG TERM RESULTS Judy Choi, Joceline Liu, Rose Khavari, Timothy Boone, and Sophie Fletcher Judy ChoiJudy Choi Houston, TX More articles by this author , Joceline LiuJoceline Liu Chicago, IL More articles by this author , Rose KhavariRose Khavari Houston, TX More articles by this author , Timothy BooneTimothy Boone Houston, TX More articles by this author , and Sophie FletcherSophie Fletcher Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurogenic bladder (NGB) with incontinence can be devastating for patients with neurologic illness. Augmentation cystoplasty with a continent catheterizable stoma creates a continent, low pressure storage system, with an easily catheterizable cutaneous stoma leading to both decreased urinary tract morbidity and increased quality of life. This study evaluates the use of a novel procedure, the ileocecal augmentation cystoplasty for patients with NGB. METHODS Retrospective chart review of modified Indiana augment procedures by a single surgeon between 1993 and 2009 was performed. Subjects with NGB and minimum 1-yr follow up were included. All patients underwent the modified Indiana continent urinary reservoir procedure in which the large bowel portion of the ileocecal segment is used to augment the native bladder. The efferent limb is tapered and the ileocecal valve is reinforced to form the continent catheterizable cutaneous stoma. Patient demographics, neurologic illness, NGB diagnosis, surgery details, concurrent operations, complications, estimated blood loss, continence outcomes and long term complications were recorded. RESULTS Fifty eight patients underwent Indiana augment, 35 met inclusion criteria. Mean age at time of surgery was 39.8 (SD 12.8) years. Neurologic diagnoses included MS (n=12), spina bifida (n=9), and spinal cord injury (n=14). Urodynamic findings were: decreased capacity (n=4), decreased compliance (n=4), detrusor external sphincter dyssynergia (n=5), detrusor overactivity with incontinence (n=3), hypocontractility (n=5), or combination (n=14). Concurrent surgeries included: bladder neck closure (n=3), pubovaginal sling (n=4), hysterectomy (n=3), artificial urinary sphincter (n=1), and cystolithotomy (n=1). Mean estimated blood loss was 253.6 mL (SD 136.5). There were no intra operative complications. Short term complications were: prolonged ileus (n=1), wound infection (n=1), low hematocrit requiring transfusion (n=1). Median follow up was 31 months. Long term complications occurred in 10 (29%) patients: recurrent cystitis (n=4), bladder stones (n=2), SBO (n=1) and stomal revision (n=3). All patients were continent at latest follow up. CONCLUSIONS This unique modification of the Indiana continent urinary reservoir is an excellent surgical option providing a low-pressure reservoir with a reliable continence mechanism and easily catheterizable stoma with few complications or need for reoperation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e474 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Judy Choi Houston, TX More articles by this author Joceline Liu Chicago, IL More articles by this author Rose Khavari Houston, TX More articles by this author Timothy Boone Houston, TX More articles by this author Sophie Fletcher Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...