Surgery for detrusor overactivity

Abstract

Intractable detrusor overactivity can result in considerable morbidity and, in the case of neurogenic bladder dysfunction, can put the upper tracts at risk. Once conservative treatments have been exhausted the aim of surgery is to increase functional bladder capacity and decrease the maximal detrusor pressure at this capacity. The mainstay of contemporary therapy has been augmentation cystoplasty; the different techniques and recent literature are reviewed herein. Bladder autoaugmentation is compared and contrasted with augmentation cystoplasty and its role is discussed, as is the less invasive technique of sacral neuromodulation with reference to their role within the range of surgical treatments for detrusor activity.

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

“…In patients with severe bladder overactivity unresponsive to anticholinergics there is evidence for the use of bladder injections of botulinum toxin A [6,7] and also emerging evidence on the use of cannabinoids [8] and tibial nerve stimulation [9]. Surgical procedures, which have been advocated with varying success [10], are a last resort being irreversible, with a risk of major operative morbidity and long-term consequences; they include augmentation cystoplasty [11], in which the bladder is transected and repaired with a patch of ileum isolated from the small intestine, and urinary diversion [12].…”

Forty-five-year follow-up on the renal function after spinal cord injury

“…A number of different techniques have been published. The results of the various procedures are very good and comparable (208,(210)(211)(212)(215)(216)(217)(255)(256)(257)(258). Bladder substitution to create a low pressure reservoir may be indicated in patients with severely thick and fibrotic bladder wall.…”

“…Since its clinical introduction by Cartwright and Snow (202) in children and by Stöhrer (203) in adults, this procedure for reducing DO or improving low detrusor compliance has gained popularity because of its acceptable long-term results, its low surgical burden, its low rate of long-term adverse effects, its positive effect on the patient's QoL, and because it does not preclude further interventions (1,4,(202)(203)(204)(205)(206)(207)(208)(209)(210)(211)(212)(213)(214)(215)(216)(217)(218)(219)(220)(221).…”

“…In the latter case, a test procedure, the percutaneous nerve evaluation (PNE), with an external stimulator is performed before the implant to judge the patient's response. This procedure also has considerable success in selected patients (210,(246)(247)(248)(249)(250).…”

Full-Thickness Hysterocystoplasty for Management of a Large Bladder Defect: Experimental Study in Goats

“…Although cystoplasty is a historic topic that has been discussed well in scientific literature and argued at legendary proportion among urologists, the search for an ideal organ to replace a diseased bladder remains elusive for reconstructive urologists [32]. Many augmentation cystoplasty or neobladder techniques have been used routinely for treatment of reduced bladder compliance and capacity secondary to bladder infection and inflammation [27], neurogenic dysfunction or congenital bladder disorders [16], detrusor over activity [10], large bladder defects [8,9], bladder necrosis [30] and bladder tumors [7,12]. Although encouraging animal and human results have been reported with different techniques, each technique had its own limitations, complications and disadvantages [2,4,11,27].…”