USE OF BLADDER STIMULATION IN HIGH-RISK PATIENTS

Purpose: We evaluated whether intravesical bladder stimulation therapy is effective in improving bladder compliance in patients with myelome ningocele, neurogenic bladder and high risk urodynamic parameters. Mat erials and Methods: We reviewed the charts of all patients treated wit h bladder stimulation therapy at our institution since 1984, and ident ified 7 with pretreatment high risk urodynamic findings (percent expec ted bladder capacity 60% or less and bladder capacity pressure 50 cm. water or greater). Urodynamic and clinical data were reviewed before a nd after therapy. Results: Following bladder stimulation in 4 of the 7 patients percent expected bladder capacity substantially increased an d bladder capacity pressure decreased to safe levels. Two patients had minimal increases in percent expected bladder capacity but bladder ca pacity pressure decreased to 50 cm. water or less. Overall percent exp ected bladder capacity increased from an average pretreatment value of 44% before to 65% after bladder stimulation (p <0.05). Average bladde r capacity pressure improved from 63.9 cm. water before to 32.3 cm. wa ter after treatment (p <0.05). Also, bladder compliance improved in al l 7 patients to the point that bladder augmentation was not performed. Conclusions: Bladder stimulation is effective in improving bladder co mpliance in high risk patients and it may be a viable alternative to e nterocystoplasty. Further long-term followup will be necessary to esta blish the longevity of this response.