Bladder Covering by Striated Muscle

Abstract

Bladder acontractility caused by a lower motor neuron lesion is an irreversible and debilitating voiding disorder affecting a large number of relatively young people. In the following, based on our pilot study (Gakis et al., J Urol 185:593–9, 2011), we present the clinical long-term results in a multicenter setting concerning the Latissimus Dorsi Detrusor Myoplasty (LDDM) in patients with an acontractile bladder for whom there is no treatment alternative than lifelong clean intermittent catheterization (CIC). From May 2001 to February 2008, 24 patients (mean age: 37 years; range: 14–63; 15 males, 9 females) were enrolled in four clinical centers worldwide requiring complete CIC 4–8 times/day. The mean follow-up was 46 months (8–89) and was carried out by questionnaire and measurement of post-void residual urine volume (PVR). Seventeen of the 24 patients (70.8%) gained complete spontaneous voiding and do not require further CIC with PVR from 0 to 100 mL. In three patients (16.5%), the frequency of CIC was reduced from 4–6 times/day preoperatively to 2–4 times/day postoperatively with RUVs from 150 to 250 mL. Twenty-one of 23 patients (91.3%) have no recurrent urinary tract infections postoperatively (mean preoperatively: 7.8/year; 0–24). At present, four patients (12.5%) need CIC 4–6 times/day as before. No functional restrictions or chronic pain of the operated upper extremity were observed in any patient. Complete (n = 17) or incomplete spontaneous voiding (n = 3) was achieved in 20 of the 24 patients (83.3%). Recurrent urinary tract infections terminated in 21 of the 23 patients postoperatively (91.3%). These results have been maintained during the long-term follow-up period of up to 7.5 years.