Complications of vesicoureteral operations from incoordination of micturition.

Recently, a study was made of 8 boys with complications after corrective surgical procedures for dysfunction of the voiding mechanism. One of these patients already had been subjected to irreversible diversion before the basic disorder was recognized but the majority was treated with suggestion (often with hypnosis) as well as with drugs affecting the smooth muscle (1 adolescent was too hostile to accept treatment). Because the bladder was dysfunctional, the operations either failed or sequelae persisted until measures such as suggestion, hypnotherapy and retraining reversed the incoordination of micturition. Operation or reoperation in 5 children might not have been necessary if bladder coordination had been established earlier. The case of boys with poor urinary control but free of neurologic stigmas are suspect. If they require an operation for repair of congenital urinary defects such as reflux, equal attention must be paid to psychologic and habit patterns causing bladder dysfunction. Otherwise, the operation is done essentially into a neurogenic bladder. It is concluded that psychologically conditioned incoordination of voiding may alone produce mid and upper tract damage. The cases of boys with problems of urinary control not explained by neurologic or anatomic defects should be suspected and corrective surgical procedures may fail if bladder dysfunction is not corrected by retraining, suggestion and even hypnotherapy.