Bladder Covering by Striated Muscle

Abstract

Bladder acontractility caused by a lower motor neuron lesion is an irreversible and debilitating voiding disorder affecting a large number of relatively young people. In the following, based on our pilot study, we presented the long-term clinical results in a multicenter setting concerning the latissimus dorsi detrusor myoplasty (LDDM) in patients with an acontractile bladder for whom there is no treatment alternative than lifelong clean intermittent catheterization (CIC) which is often linked to chronic urinary infections.

From May 2001 to February 2008, 24 patients (mean age: 37 years; range: 14–63; 15 males, 9 females) were enrolled in four clinical worldwide centers requiring complete CIC four to eight times/day. The mean follow-up was 46 months (8–89) and was carried out by questionnaire and measurement of post-void residual urine volume (PVR).

Seventeen of the 24 patients (70.8%) gained complete spontaneous voiding and did not require further CIC with PVR from 0 to 100 ml. In three patients (16.5%), the frequency of CIC was reduced from four to six times/day preoperatively to two to four times/day postoperatively with RUVs from 150 to 250 ml. Twenty-one of 23 patients (91.3%) had no recurrent urinary tract infections postoperatively (mean preoperatively: 7.8/year; 0–24). Four patients (12.5%) needed CIC four to six times/day as before. No functional restrictions and chronic pain of the operated upper extremity were observed in any patient. Complete (n = 17) or incomplete spontaneous voiding (n = 3) was achieved in 20 of the 24 patients (83.3%). Recurrent urinary tract infections terminated in 21 of the 23 patients postoperatively (91.3%). These results were maintained during the long-term follow-up period of up to 7.5 years.

Overall, the LDDM procedure is an option for a specific group of patients with an acontractile detrusor to undergo this procedure. The surgery should be performed in a center of excellence as these primary published reports have recommended. The patient needs to be informed that in approximately 30% of the cases, the LDDM procedure is not successful and the continuation of CIC will be mandatory.