Prognostic value of urodynamic testing in myelodysplastic patients

Abstract

No AccessJournal of Urology1 Feb 2002Prognostic value of urodynamic testing in myelodysplastic patients Edward J. McGuire, Jeffrey R. Woodside, Thomas A. Borden, and Robert M. Weiss Edward J. McGuireEdward J. McGuire Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author , Jeffrey R. WoodsideJeffrey R. Woodside Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author , Thomas A. BordenThomas A. Borden Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author , and Robert M. WeissRobert M. Weiss Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(02)80338-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We herein describe the clinical progress of 42 myelodysplastic patients studied urodynamically and followed for a mean of 7.1 years. Urodynamic evaluation included urethral pressure profilometry, simultaneous determination of urethral pressure, intravesical pressure and external anal or external urethral sphincter electromyography with fluoroscopic voiding cystourethrography. Assessment of urethral function showed 36 patients (86 per cent) with an open vesical outlet and nonfunctional proximal urethra. Cystometrography revealed that 7 of 42 patients (17 per cent) had reflex detrusor activity: 4 with coordinated micturition and 3 with detrusorsphincter dyssynergia. Thirty-five patients (83 per cent) had areflexic detrusor dysfunction: 5 with atonic detrusor response and 30 with a progressive increase in pressure with increasing volume. The intravesical pressure at the time of urethral leakage was 40 cm. water or less in 20 patients and at pressures greater than this value in 22 patients. No patient in the low pressure group had vesicoureteral reflux and only 2 showed ureteral dilatation on excretory urography. In contrast, of the patients in the higher pressure group 15 (68 per cent) showed vesicoureteral reflux and 18 (81 per cent) showed ureteral dilatation on excretory urography. Thus, a striking relationship between the urethral closure pressure and intravesical pressure at the time of urethral leakage and the clinical course in this group of myelodysplastic patients is demonstrated. Every patient with a normally closed vesical outlet was continent on intermittent catheterization and an anticholinergic agent, while only 60 per cent of patients with open bladder outlets similarly treated achieved good urinary control and none was dry. An artificial sphincter device would seem to be a reasonable method to achieve urinary control in the latter patients but the detrusor response to filling also must be considered. Detrusor hypertonia should be controlled or controllable before a sphincter augmenting device can be used safely. Treatment options for patients with high urethral closure pressures include intermittent catheterization and anticholinergic medications or a sphincter ablative procedure to decrease the outlet resistance combined with anticholinergic therapy and implantation of an artificial sphincter. However, only longer followup will determine if these therapeutic regimens will prevent upper urinary tract deterioration. References 1. : . Springfield, Illinois: Charles C Thomas, Publisher1965. Google Scholar 2. : . Springfield, Illinois: Charles C Thomas, Publisher1965. Google Scholar 3. : Treatment of autonomic dysreflexia with phenoxybenzamine. J. Urol.1976; 115: 53. Link, Google Scholar 4. : Detrusor-sphincter dyssynergia. J. Urol.1979; 121: 774. Link, Google Scholar 5. : The effects of sacral denervation on bladder and urethral function. Surg., Gynec. & Obst.1977; 144: 343. 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Google Scholar © 2002 by American Urological Association, IncFiguresReferencesRelatedDetailsCited byKozomara M, Birkhäuser V, Anderson C, Bywater M, Gross O, Kiss S, Knüpfer S, Koschorke M, Leitner L, Mehnert U, Sadri H, Sammer U, Stächele L, Tornic J, Brinkhof M, Liechti M and Kessler T (2022) Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic FindingsJournal of Urology, VOL. 209, NO. 1, (225-232), Online publication date: 1-Jan-2023.Hidas G, Soltani T, Billimek J, Selby B, Kelly M, McLorie G, Wehbi E and Khoury A (2017) Home Urodynamic Pressures and Volume Measurement for the Neurogenic Bladder: Initial Validation StudyJournal of Urology, VOL. 198, NO. 6, (1424-1429), Online publication date: 1-Dec-2017.Leal da Cruz M, Liguori R, Garrone G, Ottoni S, Cavalheiro S, Moron A and Macedo A (2016) A 4-Year Prospective Urological Assessment of In Utero Myelomeningocele Repair—Does Gestational Age at Birth Have a Role in Later Neurogenic Bladder Pattern?Journal of Urology, VOL. 197, NO. 6, (1550-1554), Online publication date: 1-Jun-2017.DeFoor W (2016) Challenges in Predicting Renal Outcomes in Boys with Posterior Urethral ValvesJournal of Urology, VOL. 196, NO. 3, (639-640), Online publication date: 1-Sep-2016.Khoury A (2013) Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: AugmentationJournal of Urology, VOL. 189, NO. 5, (1629-1630), Online publication date: 1-May-2013.Jorgensen B, Olsen L and Jorgensen T (2009) Natural Fill Urodynamics and Conventional Cystometrogram in Infants With Neurogenic BladderJournal of Urology, VOL. 181, NO. 4, (1862-1868), Online publication date: 1-Apr-2009. Volume 167Issue 2 Part 2February 2002Page: 1049-1053 Advertisement Copyright & Permissions© 2002 by American Urological Association, IncMetricsAuthor Information Edward J. McGuire Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author Jeffrey R. Woodside Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author Thomas A. Borden Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author Robert M. Weiss Section of Urology, Yale University School of Medicine, New Haven, Connecticut, USA Department of Urology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA More articles by this author Expand All Advertisement PDF downloadLoading ...