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The maximum detrusor pressure as a predictive factor of success after sphincterotomy in detrusor‐sphincter dyssynergia
Author(s) -
Hourié Alexandre,
Nouhaud FrancoisXavier,
Baron Maximilien,
Rebibo JohnDavid,
Pfister Christian,
Grise Philippe,
Cornu JeanNicolas
Publication year - 2018
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23759
Subject(s) - medicine , dyssynergia , detrusor sphincter dyssynergia , spinal cord injury , surgery , urology , urethral sphincter , sphincter , spinal cord , neurological disorder , urinary incontinence , central nervous system disease , psychiatry
Aims To evaluate the impact of the pre‐operative maximum detrusor pressure (MDP) on efficacy outcomes after incontinentation by sphincterotomy or urethral stent placement in male patients with neurogenic detrusor‐sphincter dyssynergia (DSD). 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 DSD confirmed by baseline urodynamic studies, and were unable or secondary failed to practice CISC. 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. Results Median (range) age was 39 years (20‐69). Spinal cord injury was the main underlying condition. Twenty‐six patients had a sphincteric stent placement (Memocath®, Bard, Covington) and 15 had surgical sphincterotomy. Treatment was successful in 31 patients (76%). Patients with immediate successful outcomes had a significantly higher mean preoperative MDP (59.6 vs 29.7 cmH 2 O; P = 0.002). Patients with MDP over the threshold of 40 cmH 2 O 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 cmH 2 O, respectively, P = 0.008). The technique used (stent placement or incision) 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 surgical sphincterotomy. A threshold of 40 mH 2 O is associated with higher success rates.