THE ROLE OF URODYNAMIC STUDIES IN THE EVALUATION OF PATIENTS WITH AUGMENTATION CYSTOPLASTIES

Objective To assess the role and value of videourodynamic studies (VUD ) in the post-operative evaluation of 100 patients who were continent following augmentation (clam) enterocystoplasty. Patients and methods Fifty patients had non-neuropathic detrusor instability and 50 had neu ropathic bladder dysfunction. All underwent standard dual channel medi um fill cystometry and synchronous video screening before and at 6 mon ths and 2 years after a clam ileocystoplasty. Results Pre-operative ca pacity was variable in nonneuropathic patients but post-operative capa city in this group, and both pre- and post-operative capacity in the n europathic group, were more reproducible. Of non-neuropathic patients, 88% became stable and 83% became normally compliant, compared with on ly 38 and 50% respectively of neuropathic patients. More surprisingly, two of eight neuropathic patients previously stable became unstable a nd four of 12 of those previously normally compliant became poorly com pliant. In all patients voiding spontaneously there was a tendency for capacity to increase and voiding efficiency to decrease with time. Co nclusions From these results, standard VUD studies contributed little to the post-operative assessment of patients with clam cystoplasties b eyond that which could be obtained by ultrasonography of the bladder b efore and after voiding. The effect or lack of effect of augmentation cystoplasty on compliance in the neuropathic bladder suggests a neurop athic effect on bowel contractility and warrants further investigation . The meaning and significance of 'urodynamic' observations when bowel is incorporated into the bladder also needs careful investigation.