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Lower urinary tract function after exstrophy closure

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Abstract

Twenty-eight children with bladder exstrophy, prior to surgery for continence, underwent a urodynamic evaluation, cystogram, ultrasound and dimercaptosuccinic acid scan, to define parameters of lower urinary tract function that are a risk for upper tract damage and/or impair development of bladder capacity. The bladders in 7 of 28 demonstrated no storage function [leak pressure)LP)=0]; but storage parameters could be measured in the other 21. Their LP was 10–35 cm H2O; 17 of 21 revealed involuntary contractions and 7 of 21 had an end-fill pressure greater than 10 cm H2O. Bladder capacity was better in those with a higher LP and those with no involuntary contractions. The 4 patients with bilateral hydronephrosis (3 of whom also had bilateral multiple scars) were among the 6 with LP greater than 30 cm H2O. Of the 7 with an end-fill pressure greater than 10 cm H2O, 5 had upper tract damage. Involuntary contractions may impair development of capacity. A LP of greater than 30 cm H2O is a risk factor for upper tract damage and an end-fill pressure greater than 10 cm H2O may also be a factor.

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Author notes

  1. Jean G. Hollowell

    Present address: Children's Hospital, Tulane University School of Medicine, 200 Henry Clay Avenue, 70118, New Orleans, LA, USA

Authors and Affiliations

  1. Department of Urology, Hospital for Sick Children, Great Ormond Street, London, UK

    Jean G. Hollowell, Patrick G. Duffy & Philip G. Ransley

  2. Department of Medical Physics, Institute of Urology, London, UK

    Patrick D. Hill

Authors
  1. Jean G. Hollowell
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  2. Patrick D. Hill
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  3. Patrick G. Duffy
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  4. Philip G. Ransley
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Hollowell, J.G., Hill, P.D., Duffy, P.G. et al. Lower urinary tract function after exstrophy closure. Pediatr Nephrol 6, 428–432 (1992). https://doi.org/10.1007/BF00874003

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  • DOI: https://doi.org/10.1007/BF00874003

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