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Related Experiment Videos

Cystometric evaluation of reconstructed classical bladder exstrophy.

S Dave1, V P Grover, S Agarwala

  • 1The Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

BJU International
|September 21, 2001
PubMed
Summary

Bladder exstrophy reconstruction outcomes show that poor bladder compliance and capacity contribute to incontinence. High bladder pressures can also cause upper tract damage, even in continent patients, highlighting the need for urodynamic assessment.

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Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Classical bladder exstrophy presents significant reconstructive challenges.
  • Post-reconstruction continence and upper tract status are critical long-term outcomes.
  • Urodynamic parameters are essential for evaluating functional success.

Purpose of the Study:

  • To investigate the relationship between urodynamic variables and continence.
  • To assess the association of urodynamic findings with upper tract status post-reconstruction.
  • To identify key factors influencing outcomes after bladder exstrophy repair.

Main Methods:

  • Thirty-one patients with bladder exstrophy underwent assessment one year after modified bladder neck reconstruction.
  • Evaluations included history, radioisotope renography, voiding cysto-urethrography, ultrasonography, and artificial slow-filling cystometry.

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  • Urodynamic variables such as capacity, compliance, and end-fill pressure were analyzed.

    • Main Results:

    • Continent patients exhibited higher maximum cystometric capacity and bladder compliance.
    • Unstable contractions occurred in 45% of patients; persistent sphincteric activity was noted in 10.
    • High end-fill pressure (> 40 cmH2O) correlated with a higher incidence of unobstructive hydronephrosis.

    Conclusions:

    • Bladder abnormalities like poor compliance, small capacity, and unstable contractions are common post-reconstruction.
    • These factors impede capacity increase and contribute to persistent incontinence.
    • Hypocompliance and high end-fill pressure pose risks to upper tract integrity, necessitating detailed urodynamic evaluation for management planning.