Rectus abdominis detrusor myoplasty (RADM) for acontractile/hypocontractile bladder in spinal cord injury patients: preliminary report

Publication date: Available online 14 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Pawan Agarwal, Shabbir Husain, Sudesh Wankhede, D. Sharma
Background-Urinary bladder dysfunction in the form of acontractile/hypocontractile bladder is very common after spinal cord injury and it may lead to recurrent urinary tract infection (UTI), stones formation, and deteriorating renal function. Conventionally, these patients evacuate their bladders by life-long clean intermittent catheterization (CIC) or an indwelling catheter (IC). For these patients, another option is to use innervated skeletal muscle wrap around the bladder to augment detrusor function and voluntary evacuation of bladder.Methods- We selected 5 patients with acontractile/hypocontractile bladder following spinal cord trauma. These patients were assessed by urodynamic study for post-void residual volume (PVRV), detrusor pressure (Pdet), urine flow rate (Vmax), and bladder contractility index (BCI). All five patients underwent Rectus Abdominis Detrusor Myoplasty (RADM). Results-Complete spontaneous voiding was achieved in all patients. Rectus abdominis detrusor myoplasty (RADM) elicits a statistically significant reduction in PVRV and statistically significant increase in urine flow rate, bladder contractility and detrusor pressure after 6 months. Recurrent UTIs ceased in all patients. There were no immediate or late complications.Conclusion- RADM appears to be a promising option in a patient with acontractile/ hypocontractile bladder to restore the bladder function. It avoids CIC in all patients leading to improvement in quality of life in select group of patients.