Neobladder Overactivity; An Equivalent To Spontaneous Rectal Contraction

December 3, 2007 – 12:22 pm | posted in Urology / Nephrology

UroToday.com - In this article published in the November issue of the International Journal of Urology, (Sakakibara and) colleagues reported a case of a 76-year-old man who, because of transitional cell carcinoma of the bladder, underwent orthotopic ileal neobladder, and developed severe nocturnal enuresis. They performed videomanometry in the ileal neobladder and the rectum of the same patient. They found that both decreased sensation and neobladder overactivity, an equivalent to spontaneous phasic contraction of the rectum, contributed to nocturnal enuresis in our patient. Therefore, bowel-targeted management is reasonable to minimize nocturnal enuresis in bladder-substituted patients.

Videomanometry of the lower gastrointestinal tract (LGIT) can reproduce normal storage and defecation of the rectum and the anus; which is the method using the same urodynamic machine but with the urethral and anal catheters upside down; e.g., in the videomanometry we use a transurethral (bladder) catheter for measuring abdominal pressure, whereas we use a transanal (rectal) catheter for slow filling (50 ml/s) and rectal pressure monitoring. For most urologists who are good at performing urodynamics, videomanometry of the LGIT is a feasible way to see patients’ bowel problems directly.

Videomanometry of the LGIT can be performed not only in bladder-substituted patients, but also in those with severe bowel dysfunction that often accompany bladder dysfunction of elderly or neurologic disorders.

Detailed methods can be seen elsewhere

1. Ito T, Sakakibara R et al. Int J Urol 2006; 13: 29-35

2. Liu Z, Sakakibara R et al. J Neurol 2005; 252: 1280-1282

3. Sakakibara R, Odaka T et al. Movement Disorders 2004; 19: 924-929

Written by R. Sakakibara MD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc… of their research by referencing the published abstract.

Link to Full Abstract

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