Functional Detrusor Myoplasty for Bladder Acontractility: Long-Term Results

Abstract

The results of this multicenter analysis demonstrate that latissimus dorsi detrusor myoplasty is an effective alternative to clean intermittent catheterization in a select group of patients with neurogenic bladder acontractility.

Detrusor underactivity: A plea for new approaches to a common bladder dysfunction

“…If an acontractile bladder is diagnosed and less invasive treatments have failed, more invasive surgical reconstructive procedures have been successfully applied to restore bladder function. Latissimus dorsi muscle transposition has been successfully used by Stenzl et al57 and results of a multicenter study have been described by Gakis et al58 Besides reconstructive procedures, tissue engineered constructs or injected stem cells59 might be considered as an option for restoring the contractile function of the bladder.…”

Bladder hypocontractility—extending the indication for LDDM

“…10 The results revealed that some degree of bladder contractility was still present in 84% of patients, although micturition parameters such as postvoid residual urine volume were not significantly altered. 10 Thus, one cannot exclude the possibility that a consider able number of patients in our study 9 might have had detrusor hypocontractility rather than acontractility. Taking this into account, it seems reasonable to broaden the indications for LDDM to patients diagnosed with detrusor hypocontractility on conventional urodynamic assessment, who until now would not have been considered candidates.…”

“…But what of the minority of cases with hypocontractile bladder or bladder acontracility? Many of the patients in our study 9 who opted for LDDM had performed CIC for several years and preoperatively reported a reduced quality of life. Over the long term, the integration of CIC into one's daily CORRESPONDENCE Bladder hypocontractility-extending the indication for LDDM…”

“…Nowadays, in light of recent data reporting long-term success rates of 70-80%, LDDM is gaining more and more acceptance in the urological community as a surgical option to restore bladder contractility without endangering the upper urinary tract. 9 However, owing to the complexity of the procedure and the rarity of the disease, LDDM is still performed only in referral centers. 9 The cost-effectiveness comparison between life-long CIC and LDDM surgery is complex and depends on the reimbursement policy of each nation's health-care system.…”

“…9 However, owing to the complexity of the procedure and the rarity of the disease, LDDM is still performed only in referral centers. 9 The cost-effectiveness comparison between life-long CIC and LDDM surgery is complex and depends on the reimbursement policy of each nation's health-care system. In a prospective randomized controlled trial, patients using hydrophilic catheters experienced less hematuria and withdrawal friction than those using uncoated catheters, but the hydrophilic catheters are associated with higher costs.…”