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Detrusor myotomy: a 5‐year review in unstable and non‐compliant bladders
Author(s) -
Potter J.M.,
Duffy P.G.,
Gordon E.M.,
Malone P.R.
Publication year - 2002
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2002.02793.x
Subject(s) - myotomy , detrusor sphincter dyssynergia , medicine , detrusor instability , urinary incontinence , spina bifida , sphincter , detrusor muscle , surgery , urinary bladder , urology , neurological disorder , central nervous system disease , achalasia , esophagus
Objective To identify urodynamic factors that might determine the clinical outcome of detrusor myotomy in incontinent children. Patients and methods Six girls and three boys (aged 5–14 years) underwent detrusor myotomy for severe urinary incontinence. Seven children had spina bifida, one had traumatic paraplegia and one had low bladder compliance. The patients were followed for a minimum of 5 years. Results Urodynamic studies before surgery showed that three patients had normal compliance with grossly unstable detrusor contractions, and six had low bladder compliance with few phasic detrusor contractions. Detrusor leak‐point pressures were > 40 cmH 2 O in five patients and < 40 cmH 2 O in four. Only two patients, both with grossly unstable detrusor contractions and leak‐point pressures of > 40 cmH 2 O, had a successful 5‐year outcome. The other seven patients remained incontinent; six underwent further surgery and one died from unrelated causes. Conclusion Detrusor myotomy appears to have the best outcome in those patients with marked phasic unstable detrusor contractions with a competent urethral sphincter. In this group it may have distinct advantages over more commonly used procedures.