title: Post-augmentation bladder perforation during urodynamic investigation.
abstract: OBJECTIVE
  To report for the first time bladder rupture during filling cystometry many years after bladder augmentation.
  
  
  METHODS
  A 17-year-old girl with T10 meningomyelocele had received an ileocystoplasty, continent catheterizable stoma, and bladder neck sling for neurogenic bladder dysfunction and intractable incontinence 8 years previously. She was continent with clean intermittent self-catheterization four times per day. Yearly urodynamics showed a bladder capacity of up to 700 ml with good compliance and low bladder pressures. In March 2006, filling cystometry was performed.
  
  
  RESULTS
  Bladder pressure was normal until 400 ml, after which it increased due to lower compliance. At 620 ml filling, the detrusor pressure was 52 cm H2O, and the patient complained suddenly of abdominal discomfort and bilateral shoulder pain, and the infusion was stopped. A catheter was placed and cystography showed intraperitoneal leakage along the left lateral bladder aspect and at the Mitrofanoff insertion site on the bladder dome. The perforations were closed via a midline incision and a ventriculoperitoneal shunt had to be exteriorized. There were no post-operative complications and a control cystogram revealed no leakage.
  
  
  CONCLUSIONS
  Augmentation ileocystoplasty has been used extensively in order to increase bladder capacity and decrease intravesical pressure. Although spontaneous or traumatic perforation of the augmented bladder has been described previously, it was never reported in correlation with urodynamic investigation. Extreme caution is warranted in the face of decreased compliance during filling cystometry in these patients, even though urodynamics showed good bladder compliance and low bladder pressures many years after ileocystoplasty.
authors.affiliation: Department of Urology, Shriners Hospital Canada, Montreal, Quebec, Canada.
authors.forename: Bertil F M
authors.initials: BFM
authors.lastname: Blok
authors.affiliation: Department of Urology, Shriners Hospital Canada, Montreal, Quebec, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Zahrani
authors.affiliation: Department of Urology, Shriners Hospital Canada, Montreal, Quebec, Canada.
authors.forename: John Paul
authors.initials: JP
authors.lastname: Capolicchio
authors.affiliation: Department of Urology, Shriners Hospital Canada, Montreal, Quebec, Canada.
authors.forename: Claudette
authors.initials: C
authors.lastname: Bilodeau
authors.affiliation: Department of Urology, Shriners Hospital Canada, Montreal, Quebec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Corcos
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007813:Laparotomy; D008591:Meningomyelocele / Q000150:complications; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery; D012421:Rupture / Q000209:etiology / Q000473:pathology; D000267:Tissue Adhesions / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014546:Urinary Catheterization / Q000009:adverse effects*; D014563:Urodynamics; D017287:Ventriculoperitoneal Shunt