Diagnostic Meaning of Urodynamic Studies in Pouch Incontinence: Results of a Small Series

Abstract

Introduction: To evaluate the meaning of urodynamic parameters in patients with pouch incontinence. Materials and Methods: Thirteen urodynamic studies in patients with an ileal nipple as the efferent segment of an ileocecal pouch or ileum/ileocecal-augmented bladder were performed. The recorded parameters included pouch capacity, leak point pressure/volume, maximum pouch pressure, compliance, static and dynamic closure pressure, and functional length. Three patients suffered from urinary incontinence. Results: In all cases of incontinent patients, no functional length or static or dynamic closure pressure could be revealed. In 8 of 10 cases of continent patients, a positive functional length as well as static and/or dynamic closure pressure were measured (mean value in continent patients: 15.9 mm, 14.5 cm H₂O and 26.5 cm H₂O, respectively). In 2 of 3 cases of incontinent patients, the pouch compliance was restricted (21 and 37 ml/cm H₂O). The pouch capacity of continent patients was greater than the capacity of incontinent patients (377.4 vs. 185.7 ml). Conclusions: Positive functional length, static and dynamic closure pressures, and a high pouch capacity with an unrestricted compliance are predictive for pouch continence. They may individually not determine continence, but combining them can. However, the meaning of urodynamic studies in pouch incontinence is not the same as with the urinary bladder.

Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence

“…In patients with OAB syndrome with failed empirical treatment, urodynamic study can provide definite information that can identify associated pathologies and/or alter the treatment course [8]. Clinically, video-urodynamic study and urodynamic study have also been used in the evaluation of the function of intracorporeally reconstructed orthotopic U-shaped ileal neobladders [9] and Studer orthotopic ileal neobladders [10] and investigation of pouch incontinence to assess the functional length, static and dynamic closure pressure, and pouch capacity [11]. …”