Detrusor myectomy: long‐term results with a minimum follow‐up of 2 years

• Published in: BJU international 2005-08, Vol.96 (3), p.341-344
• Main Authors: Kumar, Sunil P.V., Abrams, Paul H.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Child; detrusor myectomy; detrusor overactivity; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Muscle, Smooth - surgery; Nephrology. Urinary tract diseases; overactive bladder; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Treatment Outcome; Urinary Bladder - surgery; Urinary Bladder, Neurogenic - surgery; Urinary Incontinence - physiopathology; Urinary Incontinence - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics - physiology
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2005.05628.x

Detrusor myectomy was introduced as an alternative to enterocystoplasty for refractory detrusor overactivity. The early results of this procedure were described by the authors from Bristol as encouraging, and they now present their long‐term follow‐up with a median of 79 months. They found that the results were sustained in a significant group of these patients. The value of frequency‐volume urinary diaries is undoubted in patients of either sex who have LUTS, particularly in those with symptoms suggestive of overactive bladder. Authors from Chicago compare such diaries between asymptomatic controls and women with symptoms of overactive bladder. A whole range of diary variables was compared, and the interesting findings used as a potential method to define important outcome goals in therapeutic trials. OBJECTIVES To assess the long‐term results of detrusor myectomy, which has obvious theoretical advantages over enterocystoplasty for refractory detrusor overactivity (DO), and for which the early results have been encouraging. PATIENTS AND METHODS The medical records were reviewed of 30 consecutive patients (median age 33 years, range 10–62) who had a detrusor myectomy between November 1992 and April 2002 in our unit. Twenty‐four patients (80%) had idiopathic DO (six males and 18 females) and six (20%) had neurogenic DO (four males and two females). The median (range) follow‐up was 79 (28–142) months. All patients were confirmed to have DO on urodynamics before surgery and 26 (87%) had urodynamics afterward. RESULTS Nineteen (79%) of those with idiopathic DO and two with neurogenic DO showed a continued overall improvement. The cystometric capacity improved in 80% of patients after surgery, whilst the detrusor pressure at maximum flow and the bladder contractility index decreased in 60% and 78% of the patients, respectively. Ten patients (45%) had to start clean intermittent self‐catheterization after surgery. CONCLUSIONS Detrusor myectomy is successful in ≈ 80% of patients with idiopathic DO, although detrusor contractility is affected in most and almost half of the patients required clean intermittent self‐catheterization afterward. This procedure should be offered as an alternative to enterocystoplasty as it is less morbid and does not preclude subsequent surgery if required. However, further evaluation of this technique is required in neuropathic patients.