Detrusor myotomy: a 5-year review in unstable and non-compliant bladders.
OBJECTIVE
To identify urodynamic factors that might determine the clinical outcome of detrusor myotomy in incontinent children.


METHODS
Six girls and three boys (aged 5-14 years) underwent detrusor myotomy for severe urinary incontinence. Seven children had spina bifida, one had traumatic paraplegia and one had low bladder compliance. The patients were followed for a minimum of 5 years.


RESULTS
Urodynamic studies before surgery showed that three patients had normal compliance with grossly unstable detrusor contractions, and six had low bladder compliance with few phasic detrusor contractions. Detrusor leak-point pressures were > 40 cmH2O in five patients and < 40 cmH2O in four. Only two patients, both with grossly unstable detrusor contractions and leak-point pressures of > 40 cmH2O, had a successful 5-year outcome. The other seven patients remained incontinent; six underwent further surgery and one died from unrelated causes.


CONCLUSIONS
Detrusor myotomy appears to have the best outcome in those patients with marked phasic unstable detrusor contractions with a competent urethral sphincter. In this group it may have distinct advantages over more commonly used procedures.
Potter
J M
JM
Department of Urology, Battle Hospital, Reading, UK.
Duffy
P G
PG
Gordon
E M
EM
Malone
P R
PR
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009119:Muscle Contraction; D010264:Paraplegia / Q000150:complications; D011312:Pressure; D012021:Reflex, Abnormal / Q000502:physiology; D016135:Spinal Dysraphism / Q000150:complications; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology