Abstract General Information

Title

URODYNAMIC BEHAVIOR OF THE NEUROGENIC BLADDER AFTER URINARY SPHINCTER PLACEMENT

Introduction and objective

Urinary incontinence in patients with neurogenic bladder may occur due to low urethral resistance and/or decreased bladder compliance.
The objective is to evaluate the urodynamic behavior of the neurogenic bladder before and after the placement of the artificial urinary sphincter.

Method

Retrospective study in children under 18 years of age with a neurogenic bladder with urinary incontinence secondary to sphincter incompetence or stress incontinence in whom an artificial sphincter was placed between 2014 and 2023.
Pre- and post-surgical urodynamics were evaluated, with an average of 10 months after sphincter placement.
Patients with concomitant bladder enlargement surgery and incomplete pre- and postoperative studies were excluded.

Results

Between 2014 and 2023, 32 urinary sphincters were placed, 24 were in neurogenic bladders. 16 patients met the criteria, 4 female and 12 male with a mean age of 7 years (range=3-13).
In the pre-surgical urodynamics, the average of the patients presented an average pressure loss of 13 centimeters of water (range=4-33) at an average maximum bladder capacity of 55 percent in relation to the theoretical bladder capacity (range=18- 100) at that time urethral compression was performed, reaching an average maximum bladder capacity of 88 percent (range=52-100) with an average end-of-fill pressure of 29 centimeters of water (range=10-42).
The mean follow-up time was 44 months (range=11-99).
In control postoperative urodynamics, mean maximum bladder capacity was 69 percent (range=33-100) with a mean end-of-fill pressure of 33 centimeters of water (r=14-45), without urine loss.
It was observed that 10/16 patients (62 percent) had a decrease in their maximum bladder capacity compared to the preoperative maximum bladder capacity at the expense of urethral compression.

Conclusion

We conclude that in this group, the leak pressures improved in all the patients , while a decrease in bladder capacity was observed in more than half of the patients.