Supine and upright urodynamic evaluation of incontinent ileovesicostomy in wheelchair-bound adults with neurogenic bladder.

STUDY DESIGN

Prospective.

OBJECTIVES

To evaluate detrusor leak point pressure (DLPP) of the incontinent ileovesicostomy in the supine and upright position.

SETTING

California, USA.

METHODS

Urodynamic assessment of patients, 6-36 months after ileovesicostomy, was performed in the supine position and then immediately repeated in the upright position in the patient's wheelchair.

RESULTS

Upright and supine urodynamic evaluation was performed following the Good Urodynamic Practice Guidelines. Ten patients (seven male and three female) were evaluated. Etiology of neurogenic bladder (NGB) included seven patients with spinal cord injury and one patient each with multiple sclerosis, myelomeningocele and cerebral palsy. Mean DLLP in the supine position was 8.6 cm H2O (range 2-20); mean DLLP in the sitting position was 11.6 cm H2O (range 5-25). Mean change in DLPP from supine to sitting was 3.1 cm H2O (range 1-12). The difference in DLPP between supine and sitting is statistically significant (P=0.0429); however, this does not appear to be a clinically significant difference.

CONCLUSION

Ileovesicostomy is a safe option for management of the NGB in a selected patient population. A small and clinically insignificant or no change in DLPP was documented in all ten patients. We demonstrated that DLPP remains low within an ileovesicostomy while in the sitting position.