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Surgery for Underactive Bladder Treatment

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The Underactive Bladder

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Abstract

Patients with underactive bladder (UAB) have few dependable treatment options except for continuous or clean intermittent catheterization. There are essentially two main strategies to improve bladder emptying: increasing intravesical pressure and decreasing outlet resistance. The chapter will present surgical treatment options to increase bladder pressure and procedures to decrease outlet resistant.

Investigators have attempted to restore bladder contractility through correction of the myogenic component of underactive bladder. State-of-the art methods toward restoration of myogenic deficits include implantation of stem cells, transfer of an innervated skeletal muscle flap, reduction cystoplasty, and tissue engineering. These techniques will be presented.

Sphincter procedures include endoscopic incision and resection of the bladder neck, prostate, or striated external sphincter depending on site of obstruction. In addition, botulinum toxin injection has been more widely used in recent years for relief of sphincter obstruction and pelvic floor disorders. Recently, an intraurethral sphincter prosthesis with a self-contained urinary pump has been developed for use in women with UAB that will be discussed in the late-breaking Chap. 10 on advance technology.

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References

  • Atala A (2014) Regenerative bladder augmentation using autologous tissue—when will we get there? J Urol 191:1204–1205

    Article  PubMed  Google Scholar 

  • Atala A, Bauer SB, Soker S et al (2006) Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet 367:1241

    Article  PubMed  Google Scholar 

  • Bukowski TP, Perlmutter AD (1994) Reduction cystoplasty in the prune belly syndrome: a long-term follow up. J Urol 152:2113–2118

    CAS  PubMed  Google Scholar 

  • Carr LK, Robert M, Kultgen PL, Herschorn S, Birch C, Murphy M, Chancellor MB (2013) Autologous muscle derived cell therapy for stress urinary incontinence: a prospective, dose ranging study. J Urol 189:595–601

    Article  PubMed  Google Scholar 

  • Chancellor MB (1994) Detrusor myoplasty and neuromuscular electrical stimulation of the urinary bladder. US Patent: 5,370,670, 6 Dec 1994

    Google Scholar 

  • Chancellor MB, Rivas DA (1995) Current management of detrusor-sphincter dyssynergia. In: McGuire E (ed) Advances in urology. CV Mosby, St Louis, pp 291–324

    Google Scholar 

  • Chancellor MB, Smith CP (2011) Botulinum toxin in urology. Springer, Berlin

    Book  Google Scholar 

  • Chancellor MB, Rivas DA, Acosta R, Erhard MJ, Moore J, Salzman SK (1994a) Detrusor-myoplasty, innervated rectus muscle transposition study, and functional effect on the spinal cord injury rat model. Neurol Urodyn 13:547–557

    Article  CAS  Google Scholar 

  • Chancellor MB, Rivas DA, Salzman SK (1994b) Lancet. Letter 343(8898):669

    CAS  Google Scholar 

  • Chancellor MB, Bennett C, Simoneau AR et al (1999) Sphincteric stent versus external sphincterotomy in spinal cord injured men: prospective randomized multicenter trial. J Urol 161:1893–1898

    Article  CAS  PubMed  Google Scholar 

  • Chancellor MB, Yokoyama T, Tirney S, Mattes CE, Yoshimura N, de Groat WC, Huard J (2000) Preliminary results of myoblast injection into the urethra and bladder wall: a possible method for the treatment of stress urinary incontinence and impaired detrusor contractility. Neuourol Urodyn 19:279–287

    Article  CAS  Google Scholar 

  • Chen YH, Kuo HC (2004) Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions. Urol Int 73:156–161

    Article  CAS  PubMed  Google Scholar 

  • Chen SL, Bih LI, Chen GD, Huang YH, You YH, Lew HL (2010) Transrectal ultrasound-guided transperineal botulinum toxin a injection to the external urethral sphincter for treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury. Arch Phys Med Rehabil 91:340–344

    Article  PubMed  Google Scholar 

  • Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD (1988) Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 139:919–922

    CAS  PubMed  Google Scholar 

  • Fowler CJ, Betts C, Christmas T et al (1992) Botulinum toxin in the treatment of chronic urinary retention in women. Br J Urol 70:387–393

    Article  CAS  PubMed  Google Scholar 

  • Gakis G, Ninkovic M, van Koeveringe GA, Raina S, Sturtz G, Rahnama’i MS, Sievert KD, Stenzl A (2011) Functional detrusor myoplasty for bladder acontractility: long-term results. J Urol 185:593–599

    Article  PubMed  Google Scholar 

  • Gallien P, Reymann JM, Amarenco G, Nicolas B, de Seze M, Bellissant E (2005) Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol Neurosurg Psychiatry 76:1670–1676

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Huard J, Pruchnic R, Yokoyama T, Smith CP, Qu Z, Kumon H, Yoshimura N, Somogyi G, de Groat WC, Chancellor MB (2002) Muscle based gene therapy and tissue for urological dysfunction. Gene Ther 9:1617–1626

    Article  CAS  PubMed  Google Scholar 

  • Huckabay C, Nitti VW (2005) Diagnosis and treatment of primary bladder neck obstruction in men. Curr Urol Rep 6:271–275

    Article  PubMed  Google Scholar 

  • Joseph DB, Borer JG, De Filippo RE et al (2014) Autologous cell seeded biodegradable scaffold for augmentation cystoplasty: phase II study in children and adolescents with spina bifida. J Urol 191:1389–1395

    Article  CAS  PubMed  Google Scholar 

  • Kinn AC (1985) The lazy bladder-appraisal of surgical reduction. Scand J Urol Nephrol 19:93

    Article  CAS  PubMed  Google Scholar 

  • Klarskov P, Holm-Bentzen M, Larsen S et al (1988) Partial cystectomy for the myogenous decompensated bladder with excessive residual urine. Scand J Urol Nephrol 22:251–256

    Article  CAS  PubMed  Google Scholar 

  • Kuo HC (2003) Botulinum A toxin urethral injection for the treatment of lower urinary tract dysfunction. J Urol 170:1908–1912

    Article  CAS  PubMed  Google Scholar 

  • Kuo HC (2007) Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction. Urology 69:57–61

    Article  PubMed  Google Scholar 

  • Kuo HC (2008) Satisfaction with urethral injection of botulinum toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion. Neurourol Urodyn 27:793–796

    Article  CAS  PubMed  Google Scholar 

  • Levanovich PE, Diokno A, Hasenau DL, Lajiness M, Pruchnic R, Chancellor MB (2015) Intradetrusor injection of adult muscle-derived cells for the treatment of underactive bladder: pilot study. Int J Urol Nephrol 47:465–467. doi:10.1007/s11255-015-0924-1

    Google Scholar 

  • Li MD, Atkins H, Bubela T (2014) The global land-scape of stem cell clinical trials. Regen Med 9:27

    Article  CAS  PubMed  Google Scholar 

  • Lim SK, Quek PL (2008) Intraprostatic and bladder-neck injection of botulinum A toxin in treatment of males with bladder-neck dyssynergia: a pilot study. Eur Urol 53:620–625

    Article  CAS  PubMed  Google Scholar 

  • Madersbacher H, Scott FB (1975) Twelve o’clock sphincterotomy. Urol Intern 30:75–81

    Article  CAS  Google Scholar 

  • Padmanabhan P, Nitti VW (2007) Primary bladder neck obstruction in men, women, and children. Curr Urol Rep 8:379–384

    Article  PubMed  Google Scholar 

  • Schurch B, Hauri D, Rodic B et al (1996) Botulinum-A toxin as treatment of detrusor sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol 155:1023–1029

    Article  CAS  PubMed  Google Scholar 

  • Smith CP, Nishiguchi J, O’Leary M, Yoshimura N, Chancellor MB (2005) Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology 65:37–41

    Article  PubMed  Google Scholar 

  • Stenzl A, Ninkovic M, Kollé D et al (1998) Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle. Lancet 351:1483–1485

    Article  CAS  PubMed  Google Scholar 

  • Van Savage JG, Perez-Abadia GP, Palanca LG et al (2000) Electrically stimulated detrusor myoplasty. J Urol 164:969–972

    Article  PubMed  Google Scholar 

  • von Heyden B, Anthon JP, Brock GB et al (1998) The latissimus dorsi bladder myoplasty to assist detrusor function. Urol Res 26:215–221

    Article  Google Scholar 

  • Wang SC, McGuire EJ, Bloom DA (1989) Urethral dilation in the management of urological complications of myelodysplasia. J Urol 142:1054–1055

    CAS  PubMed  Google Scholar 

  • Yang CC, Mayo ME (1995) External urethral sphincterotomy: long-term follow-up. Neurourol Urodyn 14:25–31

    Article  CAS  PubMed  Google Scholar 

  • Yokoyama T, Huard J, Chancellor MB (2000) Myoblast therapy for stress incontinence and bladder dysfunction. World J Urol 18:56–61

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Aikens Research Center, Oakland University William Beaumont School of Medicine, Rochester, MI, USA

    Michael B. Chancellor MD

  2. Neurourology Program, Beaumont Health System, Royal Oak, MI, USA

    Michael B. Chancellor MD

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  1. Michael B. Chancellor MD
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Correspondence to Michael B. Chancellor MD .

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Editors and Affiliations

  1. Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA

    Michael B. Chancellor

  2. Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA

    Ananias C. Diokno

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Chancellor, M.B. (2016). Surgery for Underactive Bladder Treatment. In: Chancellor, M., Diokno, A. (eds) The Underactive Bladder. Springer, Cham. https://doi.org/10.1007/978-3-319-23687-2_9

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  • DOI: https://doi.org/10.1007/978-3-319-23687-2_9

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23686-5

  • Online ISBN: 978-3-319-23687-2

  • eBook Packages: MedicineMedicine (R0)

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