Post-augmentation bladder perforation during urodynamic investigation.

Abstract:

AIMS:To report for the first time bladder rupture during filling cystometry many years after bladder augmentation. METHODS:A 17-year-old girl with T10 meningomyelocele had received an ileocystoplasty, continent catheterizable stoma, and bladder neck sling for neurogenic bladder dysfunction and intractable incontinence 8 years previously. She was continent with clean intermittent self-catheterization four times per day. Yearly urodynamics showed a bladder capacity of up to 700 ml with good compliance and low bladder pressures. In March 2006, filling cystometry was performed. RESULTS:Bladder pressure was normal until 400 ml, after which it increased due to lower compliance. At 620 ml filling, the detrusor pressure was 52 cm H2O, and the patient complained suddenly of abdominal discomfort and bilateral shoulder pain, and the infusion was stopped. A catheter was placed and cystography showed intraperitoneal leakage along the left lateral bladder aspect and at the Mitrofanoff insertion site on the bladder dome. The perforations were closed via a midline incision and a ventriculoperitoneal shunt had to be exteriorized. There were no post-operative complications and a control cystogram revealed no leakage. CONCLUSIONS:Augmentation ileocystoplasty has been used extensively in order to increase bladder capacity and decrease intravesical pressure. Although spontaneous or traumatic perforation of the augmented bladder has been described previously, it was never reported in correlation with urodynamic investigation. Extreme caution is warranted in the face of decreased compliance during filling cystometry in these patients, even though urodynamics showed good bladder compliance and low bladder pressures many years after ileocystoplasty.

journal_name

Neurourol Urodyn

authors

Blok BFM,Al Zahrani A,Capolicchio JP,Bilodeau C,Corcos J

doi

10.1002/nau.20394

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

540-542

issue

4

eissn

0733-2467

issn

1520-6777

journal_volume

26

pub_type

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