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Bladder hypocontractility—extending the indication for LDDM

Nature Reviews Urology volume 9, pages 231–232 (2012)Cite this article

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Since its clinical inauguration more than a decade ago, latissimus dorsi detrusor myoplasty (LDDM) has provided a new option for treating patients with impaired bladder contractility, who would otherwise have had to rely on lifelong clean intermittent catheterization (CIC). Dr Ginsberg's thoughtful comment on our long-term multicenter investigation with LDDM (Bladder acontractility: detrusor myoplasty and other options. Nat. Rev. Urol. 8, 185–186; 2011)1 raises some interesting aspects of our study that warrant further consideration.

Impaired bladder contractility owing to lower motor neuron lesion is a debilitating disorder, often affecting young patients. Tolerance of and adherence to CIC—the standard procedure for bladder emptying—2,3 is of the utmost importance to prevent functional deterioration of the lower and upper urinary tract.4 Nevertheless, even with strict adherence to CIC the risk of UTI, macrohematuria, urethral stricture and bladder stones cannot be ignored. For example, a prospective study that investigated 170 patients using CIC for neurogenic or non-neurogenic bladder dysfunction reported a 35% rate of clinically apparent UTIs that substantially impaired well-being.5 However, it is certainly true that not all patients on CIC bear a psychological and socioeconomic burden. Some studies have noted an improvement in quality of life in 60% of patients,6 although the converse—the 40% who did not report a significant benefit—begs noting.

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References

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Authors and Affiliations

  1. Department of Urology, University Hospital Tuebingen, Hoppe-Seyler Street 3, Tuebingen, D-72076, Germany

    Georgios Gakis & Arnulf Stenzl

  2. *nbsp;Department of Plastic and Reconstructive Surgery, Hospital Munich-Bogenhausen, Englschalkinger Strasse 77, D-81925 Munich, Germany,

    Milomir Ninkovic

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  1. Georgios Gakis
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  2. Milomir Ninkovic
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  3. Arnulf Stenzl
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Correspondence to Georgios Gakis.

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Gakis, G., Ninkovic, M. & Stenzl, A. Bladder hypocontractility—extending the indication for LDDM. Nat Rev Urol 9, 231–232 (2012). https://doi.org/10.1038/nrurol.2011.27-c1

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