Feasibility of on-table ureteric occlusion urodynamics (OUOU): an important technique to measure capacity and compliance in patients with VUR
BAUS ePoster online library. MacAskill F. Jun 24, 2019; 259520; P3-6 Disclosure(s): None
Mr. Findlay MacAskill
Mr. Findlay MacAskill
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Abstract
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Background: Accurately assessing bladder capacity, compliance and pressure in patients with vesico-ureteric reflux (VUR) is difficult due to the dampening effect of dilated upper tracts. Standard video-urodynamics (UDS) can significantly underestimate bladder pressure. Therefore, it is possible to mis-interpret the safety of the lower urinary tract prior to transplantation, especially if upper tract infection may warrant native nephrectomy. To compare bladder capacity and pressure measurements performed with and without ureteric balloon occlusion (OUOU) in patients with VUR.
METHODS:
Ureteric balloon occlusion was achieved with hysterosalpingogram catheters (single lumen 5.5 Fr catheter; 1.5 ml balloon) positioned into the distal ureters at cystoscopy under general anaesthesia. Catheter balloons were inflated with 1.5 ml of contrast. A dual lumen urodynamic catheter was inserted into the bladder. Bladder filling was at 10 ml/min. We recorded bladder capacity and compliance (C= ∆bladder volume/∆detrusor pressure) with and without ureteric occlusion.
RESULTS:
A female patient underwent standard UDS and OUOU. With standard UDS, VUR occurred after 80mls of bladder filling and urodynamic calculations suggested normal compliance. After OUOU, there was marked loss of compliance (Pdet >55 cmH2O) after 160 ml of bladder filling.
Conclusion: On-table urodynamics with ureteric occlusion (OUOU) permits more accurate assessment of lower urinary tract capacity and compliance in isolation from the upper urinary tract. This is a particularly important test for urologists to perform selectively as part of pre-transplant bladder assessment in patients with VUR.
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