Outcomes of Reduction Cystoplasty in Men With Impaired Detrusor Contractility

• Published in: Urology (Ridgewood, N.J.) Vol. 83; no. 4; pp. 882 - 887
• Main Authors: Thorner, Daniel A, Blaivas, Jerry G, Tsui, Johnson F, Kashan, Mahyar Y, Weinberger, James M, Weiss, Jeffrey P
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2014; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cystoscopy - methods; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Muscle Contraction; Muscle, Smooth - pathology; Nephrology. Urinary tract diseases; Postoperative Period; Prostatectomy - methods; Retrospective Studies; Treatment Outcome; Urinary Bladder - surgery; Urinary Bladder Neck Obstruction - surgery; Urinary Catheterization; Urodynamics; Urologic Surgical Procedures; Urology; Human; Cystoplasty; Nephrology; Prognosis; Contractility; Male; Urology; Plasty; Reduction; Treatment; Surgery; Detrusor muscle; Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2013.10.068

Objective To report surgical outcomes in patients with impaired detrusor contractility (IDC) treated with reduction cystoplasty (RC). Methods This was a retrospective study of consecutive patients with IDC who underwent RC. IDC was defined as a bladder contractility index of <100 and/or a detrusor contraction of insufficient duration resulting in a postvoid residual volume (PVR) >600 mL. Bladder outlet obstruction was defined by a bladder outlet obstruction index (BOOI) >40. All patients had preoperative International Prostate Symptom Score, maximum uroflow ( Qmax ), PVR, bladder diary, videourodynamics, and cystoscopy. Patients with prostatic obstruction underwent synchronous open prostatectomy. Postoperative Qmax , PVR, need for clean intermittent catheterization (CIC), and Patient Global Impression of Improvement (PGII) score were obtained. Follow-up was at 3 months, 1 year, and yearly thereafter. Results Eight men met inclusion criteria (mean age, 60; range, 43-75 years). Preoperatively, 3 of 8 patients (37.5%) had moderate-sized bladder diverticula, 4 of 8 (50%) had a bladder contractility index <100, and 6 of 8 (75%) had a BOOI <40. Two patients (25%) fulfilled criteria for bladder outlet obstruction (BOOI, 67 and 72). Three (37.5%) underwent synchronous bladder diverticulectomy, and 3 (37.5%) underwent suprapubic prostatectomy. All patients were available for follow-up at 1 year. Seven of 8 (88%) had a successful outcome (PGII ≤2). One patient was unchanged (PGII, 4) and still needed CIC. Conclusion All but 1 patient who met specific criteria for RC had excellent outcomes after surgery based on the PGII, PVR, Qmax , and need for CIC. RC is a viable option for properly selected patients with IDC.