title: Combined cystometrography and electromyography of the external urethral sphincter following complete primary repair of bladder exstrophy.
abstract: OBJECTIVE
  Concern in patients with bladder exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of bladder exstrophy. We determined whether complete primary repair of bladder exstrophy would adversely affect the innervation controlling bladder and external urethral sphincter function.
  
  
  METHODS
  Complete primary repair of bladder exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding.
  
  
  RESULTS
  Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary repair of bladder exstrophy. Age at study and time after complete primary repair of bladder exstrophy was 3 months to 10 years (median 11.5 months). Cystometrography revealed absent detrusor overactivity and the presence of a sustained detrusor voiding contraction in all cases. Electromyography showed universally normal individual motor unit action potentials of biphasic pattern, amplitude and duration. The external urethral sphincter sacral reflex response was intact with a normal caliber with respect to Valsalva, Credé, bulbocavernosus and anocutaneous (bilateral) stimulation. Synergy was documented by abrupt silencing of external urethral sphincter electromyography activity during voiding.
  
  
  CONCLUSIONS
  After complete primary repair of bladder exstrophy combined cystometrography/electromyography in patients with bladder exstrophy showed normal neurourological findings, including sacral reflex responses, sustained detrusor voiding contraction and synergic voiding, in all patients postoperatively. These findings confirm the safety of complete primary repair of bladder exstrophy. Based on our results we have discontinued routine electromyography in these patients.
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts. Electronic address: joseph.borer@childrens.harvard.edu.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
authors.forename: Ruth
authors.initials: R
authors.lastname: Strakosha
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Bauer
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
authors.forename: Melanie
authors.initials: M
authors.lastname: Pennison
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
authors.forename: Ilina
authors.initials: I
authors.lastname: Rosoklija
authors.affiliation: Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
authors.forename: Shahram
authors.initials: S
authors.lastname: Khoshbin
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000294:innervation*; D001743:Urinary Bladder / Q000294:innervation*; D014563:Urodynamics
keywords: bladder exstrophy; complications; electromyography; reconstructive surgical procedures; urodynamics