[A new method for assessing sphincter resistance, in patients with low compliant bladder]

Since 1990, in our department we have planned out a test to find out the grade of sphincteric resistance in patients with low compliant bladders. In order to know which patients will have a sufficient sphincteric resistance to achieve satisfactory continence after bladder augmentation and which patients will not have sufficient sphincteric resistance, needing procedures to increase outlet resistance along with bladder augmentation. This test consisted in: to determine what volume the bladder can admit at a detrusor pressure of 10 cm H2 O, we fill the bladder at that volume and then, we check if the patient had leaks with abdominal pressure increases. The study was carried out in 15 patients with low compliant bladders and suffering from incontinence, who had not responded to I.C. and anticholinergic therapy, who was to undergo bladder augmentation. In 12 patients the test was negative and in 3 was positive. After bladder augmentation, all patients with negative tests, are completely dry, and the three patients whose test was positive, in spite of having urodynamically normal neobladder they remain incontinent. In our opinion, this test is simple to perform and very useful diagnostic tool to known which patients beside bladder augmentation, may need procedures to increase outlet resistance.