Low amplitude rhythmic contractions (LARC), visualized as phasic intravesical pressure (pves) changes, are commonly seen during urodynamics (UD). A significant rise in pves will increase bladder wall tension and can elicit an increase in sensation. LARC are dampened by the viscoelasticity of the bladder, and not all elevations in bladder wall tension are expected to be sufficient to cause an increase in sensation. This study aims to determine thresholds for pves amplitude elevations that trigger patient-reported changes in sensation during filling.METHODS: As part of an IRB-approved urodynamics (UD) protocol, patients with overactive bladder syndrome (OAB), defined as ICIq-OAB question 5a ¼ 3, underwent standard UD testing and simultaneously used a real-time sensation meter to record continuous changes in sensation from 0-100% during filling. Patients were instructed on use of the meter prior to the study. Sensation values were time-linked to pves. Normalized pves was differentiated to identify inflection points, and baseline pves was calculated via polynomial regression (Figure 1). Significant elevation in pves from baseline was defined as ¼ 5% normalized value, while any elevation in patient-reported sensation (values sampled every 10 sec) was considered significant. Significant phasic rises in pves were juxtaposed to sensation changes to determine if pves and sensation events coincided.RESULTS: Twelve patients underwent UD with use of the sensation meter e 3 were excluded (transducer error, fill to 30mL, only 10% sensation reached). Average phasic pves and sensation change event frequencies during filling were similar: 2.0AE0.2 & 2.1AE0.3 cycles/ min, respectively (p¼0.9). Of sensation changes, 53AE8% were within 10 sec of significant pves elevations (average ?pves ¼ 20AE3% normalized minimum).CONCLUSIONS: The frequency of changes in patient-reported sensation during filling correspond with phasic pves elevations, generated by LARC. Further refinement of sensation thresholds may allow development of non-invasive techniques to better characterize a LARC-mediated subtype of OAB.
We present a series of robotic-assisted laparoscopic ileovesicostomies with bowel work performed completely intracorporeally. The four patients selected for this procedure were all diagnosed with neurogenic bladder and failed conservative medical therapy. Preoperative patient data included age, body mass index (BMI), and urodynamic (UD) study results. Intra-operative data included estimated blood loss (EBL), operative time, and intra-operative complications. Post-operative data included return to bowel function, post-operative complications, and length of hospital stay (LOS). All bowel work was completed intracorporeally with the exception of stoma maturation. Four robotic ileovesicostomies were performed. Pre-operative urodynamic study results showed either elevated detrusor pressures or limited bladder capacities in addition to the inability to perform self-catheterization. The mean patient age was 40 years and mean BMI was 26 kg/m2. Average EBL and operative time were 131 ml and 290 min, respectively. No intra-operative complications occurred. Bowel function, as defined as flatus, returned on average 3.8 days after surgery and average LOS, defined as discharge home or discharge to the spinal cord unit, was 7.5 days. Mean follow-up time was 25.8 months. Post-operative urodynamic studies revealed low stomal leak point pressure (<10 cmH2O). This study is the first to describe a completely intracorporeally robotic-assisted laparoscopic ileovesicostomy with safe and effective outcomes after more than 2 years of follow-up.
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