title: Functional detrusor myoplasty for bladder acontractility: long-term results.
abstract: OBJECTIVE
  We present the long-term results of a multicenter investigation with latissimus dorsi detrusor myoplasty in patients with bladder acontractility caused by lower motor neuron lesion in whom there is no treatment alternative other than lifelong clean intermittent catheterization.
  
  
  METHODS
  From 2001 to 2008, 24 patients (median age 39 years, range 13 to 63, 16 males, 8 females) requiring complete clean intermittent catheterization 4 to 7 times daily underwent latissimus dorsi detrusor myoplasty at 4 centers worldwide. Before the procedure patients were on clean intermittent catheterization for a median of 55 months (range 17 to 195). Median followup was 46 months (range 8 to 89) and was performed by urodynamics and measurement of post-void residual urine volume. Bladder contractility index was calculated. The t test was used for statistical analysis.
  
  
  RESULTS
  Of the 24 patients 17 (71%) gained complete spontaneous voiding with a mean post-void residual urine volume of 25 ml (range 0 to 100). Mean bladder contractility index increased from 20.1 ± 7.6 to 176.2 ± 25.4 (p <0.001). In 3 patients (13%) the frequency of clean intermittent catheterization was reduced to 2 to 4 times daily with a mean post-void residual urine volume of 200 ml (range 150 to 250). Mean bladder contractility index was 12.0 ± 7.2 preoperatively and 68.7 ± 28.1 postoperatively (p = 0.12). Recurrent urinary tract infections (defined as the presence of clinical symptoms such as dysuria and fever, and microbiological evidence of germs) ceased in 21 of 23 patients (91%, mean preoperatively 8 per year). Four patients (17%) required clean intermittent catheterization with the same frequency as before the procedure (mean bladder contractility index preoperatively 22.5 ± 10.3 and postoperatively 26.0 ± 12.3, p = 0.83). No chronic pain at the donor site or vesicoureteral reflux was observed in any patient.
  
  
  CONCLUSIONS
  The results of this multicenter analysis demonstrate that latissimus dorsi detrusor myoplasty is an effective alternative to clean intermittent catheterization in a select group of patients with neurogenic bladder acontractility.
authors.affiliation: Department of Urology, Eberhard-Karls University, Tuebingen, Germany. georgios.gakis@med.unituebingen.de
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: Milomir
authors.initials: M
authors.lastname: Ninkovic
authors.forename: Gommert A
authors.initials: GA
authors.lastname: van Koeveringe
authors.forename: Shailesh
authors.initials: S
authors.lastname: Raina
authors.forename: Gustavo
authors.initials: G
authors.lastname: Sturtz
authors.forename: Mohammad S
authors.initials: MS
authors.lastname: Rahnama'i
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057928:Intermittent Urethral Catheterization / Q000379:methods; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000503:physiopathology / Q000601:surgery*; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D009130:Muscle, Smooth / Q000503:physiopathology / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000294:innervation*; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D016055:Urinary Retention / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D014554:Urination / Q000502:physiology; D055815:Young Adult