Lower urinary tract function after exstrophy closure.
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.
Hollowell
J G
JG
Department of Urology, Hospital for Sick Children, London, UK.
Hill
P D
PD
Duffy
P G
PG
Ransley
P G
PG
D001746:Bladder Exstrophy / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D004113:Succimer; D014463:Ultrasonography; D014549:Urinary Incontinence / Q000601:surgery; D014551:Urinary Tract / Q000000981:diagnostic imaging / Q000473:pathology; D014553:Urinary Tract Physiological Phenomena; D014563:Urodynamics
D004113:Succimer