1014A 20 YEAR FOLLOW-UP OF UROLUME WALLSTENT™ IN THETREATMENT OF DETRUSOR EXTERNAL SPHINCTERDYSSYNERGIA IN SPINAL CORD INJURY PATIENTS

Ahmad Abdul-Rahman*, Soran ismail, Rizwan Hamid, Julian Shah,London, United Kingdom

INTRODUCTION AND OBJECTIVES: To assess the long-term(20 years) effectiveness of the UroLume Wallstent™ in the treatment ofdetrusor external sphincter dyssynergia (DSD) in spinal cord injuredpatients.

METHODS: Twelve patients with quadriplegia secondary tospinal trauma underwent external striated sphincter stenting with theUroLume Wallstent™ in place of sphincterotomy for DSD about 20years ago. The mean age was 41.8 years (range 26-65 years). Elevenpatients had cervical level injury whilst 1 had a thoracic injury. Allpatients were shown to have high-pressure neurogenic detrusor over-activity and DSD with incomplete emptying on pre-operative video-cystometrograms (VCMG).

RESULTS: Six of twelve patients now have been followed upfor a mean of 20 years (range 19 years ¡V 21 years). Of the remaining6, two were lost to follow up at 1 and 3 years, however, both remainedfree of complications during that time. Two patients developed encrus-tation causing obstruction, requiring stent removal within a year ofinsertion. Another patient with an adequately functioning stent died 7years post operatively with chest infection. The twelfth patient devel-oped bladder cancer 14 years after stent insertion and underwentcystectomy with urinary diversion. VCMG follow-up of the 6 patientsshowed a significantly sustained reduction of maximum detrusor pres-sure and duration of detrusor contraction at 20 years follow-up. Five ofthese six patients developed bladder neck dyssynergia of varyingdegree as demonstrated on VCMG within the first 9 years of follow-up.All were successfully treated with bladder neck incision where the lastBNI needed was at 12 years. We did not encounter any problem withstent migration, urethral erosion, erectile dysfunction or autonomicdysreflexia.

CONCLUSIONS: Urethral stenting using the UroLume Wall-stent,,� is effective in the management of DSD in the spinal injuredpatients and provides an acceptable long-term (20 year follow-up)alternative to sphincterotomy. The failures manifest within the first fewyears and can be managed easily with stent removal without anysignificant problems. Bladder neck dyssynergia was the long termcomplication which was treated successfully with BNI. It has no signif-icant interference with erectile function, being reversible, minimallyinvasive and a shorter hospital stay.

Source of Funding: None

10157 YEAR FOLLOW UP OF THE FIRST GROUP OF PATIENTSWITH NEUROGENIC DETRUSOR OVERACTIVITY RECEIVINGBOTULINUM TOXIN-TYPE A (DYSPORT).

Ahmad Abdul-Rahman*, Prasad Patki, Rizwan Hamid, Julian Shah,London, United Kingdom

INTRODUCTION AND OBJECTIVES: Botulinum toxin–A hasshown promising results in the management of neurogenic detrusoroveractivity (NDO). Most of the reports in the literature have utilisedBOTOX [Allergan, Irvine, CA, USA]. We assessed the long term out-come of BTX-A (Dysport, Ipsen, Luxembourg; 1000 units) in the treat-ment of drug-resistant NDO in spinal cord injury (SCI) patients.

METHODS: We performed a retrospective analysis of 37 SCIpatients with NDO who had BTX-A (Dysport, 1000 units) injectedcystoscopically into the detrusor muscle in our Neuro-Urology depart-ment. The maximum cystometric capacity (MCC), maximum detrusorpressure (MDP), NDO, continence, and anticholinergics usage wereused as outcome variables.

RESULTS: The mean follow-up was 7 years (3-8 years). MeanBTX-A injections were 4 (1-6 injections) per patient. 20/37 patients

(54%) continued to have the intradetrusor Dysport injections every 12to 18 months with clinical and VCMG proven improvement. The MCCincreased from a mean of 259 to 520 ml (p 0.0001), and the MDPdecreased from a mean of 54 to 25 cmH2O (p 0.01). The incontinenceand NDO were abolished in 85% and 80% respectively in this subset ofpatients. Anticholinergics were stopped in 15/20 (75%) patients and theremaining 5/20 patients were able to reduce the dosage. Two patients2/37 (5.5%) failed to improve after two injection sessions and under-went Clam Ileocystoplasty. Personal convenience and infection withsuprapubic pain were the reasons for 8/37 (22%) to chose to revertback to oral medications on long term after achieving significant benefitfrom intradetrusor Dysport. The remaining 7/37 patients (18.5%) werelost to follow up.

CONCLUSIONS: Injection with BTX-A (DYSPORT) is an effec-tive and sustainable treatment of NDO in SCI patients. It bridges thegap between oral and invasive surgical treatment of drug-resistantNDO. With a low dropout rate it provides a credible alternative tosurgery in patients with SCI.

Source of Funding: None

1016THE PREVALENCE OF OVERACTIVE BLADDER SYMPTOMS INPATIENTS WITH MULTIPLE SCLEROSIS AND CORRELATIONSWITH INCREASED DISABILITY AS WELL AS REDUCEDQUALITY OF LIFE

Sangeeta Mahajan*, Shaker Heights, OH; Pragna Patel, Cleveland,OH; Ruth Ann Marrie, Winnipeg, Canada

INTRODUCTION AND OBJECTIVES: Overactive bladder(OAB) symptoms are common in patients with Multiple Sclerosis (MS).Our goal is to determine the prevalence of OAB symptoms in patientswith MS and correlations with physical disability and quality of life(QoL).

METHODS: After obtaining IRB exemption, results from the Fall2005 North American Research Committee On Multiple Sclerosis sur-vey were reviewed, including the Urogenital Distress Inventory (UDI-6)an additional nocturia question, the SF-12, the Patient DeterminedDisease Steps (PDDS) measuring physical disability, and questions onurologic care. A total OAB symptom score was created by summingresponses to the UDI-6 frequency, urgency, small leakage and nocturiaquestions, totaling 0 to 12. Data were analyzed using descriptivestatistics, the chi-square and Student’s t-tests, analysis of variance,and multivariate logistic regression.

RESULTS: Of 16,858 surveys mailed, 9702 (58%) were re-turned (75% women and 25% men). Participants with a surgicallyaltered bladder were excluded (N�21). Of 6981 respondents, 6263(65%) had at least one UDI-6 score �2 (moderate to severe), including44% frequency, 41% urgency, 22% leakage and 46% nocturia, with amedian OAB symptom score 5.1. Longer disease duration (r � 0.135,p�0.001) and increasing disability (r�0.291, p�0.001) were signifi-cantly correlated with an increasing OAB symptom score. Lower SF-12scores were associated with increasing disability (p�0.001). Whencontrolled for disability, both physical (PCS-12, r�0.17) and mental(MCS-12, r�0.16) QoL were reduced with increasing OAB symptomscores (p�0.001). Only 2361 (51%) respondents with moderate tosignificant OAB symptoms had ever been treated with an anti-cholin-ergic medication. Treated patient were more likely to have leakagecomplaints (p�0.001) and to receive oxybutynin or tolterodine whilenewer options were under utilized (�10% total use). Only 56% ofrespondents with a OAB symptom score score � 5 had ever undergoneany urologic evaluation, associated with longer disease duration,higher UDI-6 score, and unemployed status (all p�0.001).

CONCLUSIONS: This is the first large scale study to identifysignificant rates of moderate to severe OAB symptoms in MS patients.A significant correlation exists between increasing physical disability,longer MS duration and increasing OAB symptoms. Currently many ofthese patients remain underserved and untreated.

Source of Funding: None

Vol. 183, No. 4, Supplement, Monday, May 31, 2010 THE JOURNAL OF UROLOGY� e395