Use of bladder stimulation in high risk patients

Purpose: We evaluated whether intravesical bladder stimulation therapy is effective in improving bladder compliance in patients with myelomeningocele, neurogenic bladder and high risk urodynamic parameters. Materials and Methods: We reviewed the charts of all patients treated with bladder stimulation therapy at our institution since 1984, and identified 7 with pretreatment high risk urodynamic findings (percent expected bladder capacity 60% or less and bladder capacity pressure 50 cm. water or greater). Urodynamic and clinical data were reviewed before and after therapy. Results: Following bladder stimulation in 4 of the 7 patients percent expected bladder capacity substantially increased and bladder capacity pressure decreased to safe levels. Two patients had minimal increases in percent expected bladder capacity but bladder capacity pressure decreased to 50 cm. water or less. Overall percent expected bladder capacity increased from an average pretreatment value of 44% before to 65% after bladder stimulation (p <0.05). Average bladder capacity pressure improved from 63.9 cm. water before to 32.3 cm. water after treatment (p <0.05). Also, bladder compliance improved in all 7 patients to the point that bladder augmentation was not performed. Conclusions: Bladder stimulation is effective in improving bladder compliance in high risk patients and it may be a viable alternative to enterocystoplasty. Further long-term followup will be necessary to establish the longevity of this response.