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QUANTIFICATION
OF INSTABILITY/HYPERREFLEXIVITY USING POWER AND WORK FACTORS, NUMBER
OF PULSES, AND PULSE AMPLITUDE
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Authors:
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EF Wahl, TT Lahdes-Vasama*
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Institution:
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Clark Morrison Children's
Urological Clinic, Dept. Of Urology, UCLA School of Medicine, Los
Angeles, CA, USA * Hospital for Children and Adolescents, Helsinki
University Central Hospital, Finland
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Aims of
Study
To show that the severity of the instability/hyperreflexivity can be quantified
with parameters.
Methods
The cmgs of 20 patients (9 non-neurogenic, 11 neurogenic disorders) with unstable/hyperreflexive
bladders were analyzed to determine the power and work factors, the number of
detrusor pressure pulses less than 15 cmw, more than 15 cmw, and the average
amplitude in each using the method previously described (1,2). The compliance
was also determined by dimensionless number Nwahl (2,3). This data was then
organized in table in order of increasing severity of detrusor overactivity.
Results
As would be expected myelomeningocele (mmc) patients have high normalized power
factors (NPF). But as known not all mmc patients have same problems; 1-year
old girl (case 8) has both good bladder compliance and stability; 4-months old
boy (case 20) has excellent compliance and but the bladder is very hyperreflexive;
the bladders of cases 6 and 12 have poor compliance without any significant
detrusor overactivity; 12-year old boy's bladder (case 17) has extremely poor
compliance but only slightly overactive detrusor. Patients with augmented bladders
(cases 11 and 13) presented mainly low amplitude pulsations on cmg. Amount of
instability varied significantly between the patients with wetting problems.
Only minimal instability was seen in poorly compliant bladders of patients with
urethral valve, bladder extrophy and Hinman bladder (cases 10, 7, and 5).
Conclusions
This method is a useful tool for assessing the severity of the condition and
choosing a right treatment for a patient. Also, in serial testing the method
can be used for estimating efficacy of a treatment or following a natural course
of certain condition.
References
1. Quantification of detrusor compliance and contractility. Society for Urological
Engineering, AUA annual meeting, 1998.
2. Quantification of detrusor compliance and contractility. Submitted to Neurourology
and Urodynamics, March 2000.
3. Quantification of bladder compliance by a dimensionless number. Submitted
to Neurourology and Urodynamics, February 2000.