NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Low Bladder Compliance is a Risk Factor for Bladder Diverticula and/or Vesico-ureteral Reflux on Fluoroscopic Urodynamic Studies
John T. Stoffel, MD, Christopher Lodowsky, MD, John F. Bresette, MD.
Lahey Clinic, Burlington, MA,

Background: Risk factors for bladder diverticula and vesicoureteral reflux (VUR) have not been fully defined in the adult population. Our purpose was to determine if patients with low bladder compliance on cystometrogram were at higher risk for associated radiologic findings of bladder diverticula and VUR during fluoroscopic urodynamic studies.
Methods: Medical records were retrospectively reviewed for 254 consecutive patients studied between 5/05 and 3/06 with a Laborie Aquarius (Williston, VT) multichannel urodynamic system synchronized with fluoroscopic imaging. Studies were classified as evaluations of Neurogenic, Obstructive, or Incontinent symptoms based on the predominant pre-test findings from medical history and physical exam. Patients were studied in the standing or upright position with rectal/ bladder air charged catheters and filled at a rate of 55-77 cc/minute with Renografin (Bracco Diagnostics Inc, Princeton NJ) until the feeling of strong urge, an uninhibited detrusor contraction causing incontinence, or a 400 cc volume limit. Fluoroscopic images were regularly taken in the anterior-posterior and lateral positions during the filling and emptying phases of the study. Bladder compliance was calculated as infused volume over change in detrusor pressure (cc/cm H20). Low compliance was defined as < 20 cc/cm H20. A bladder diverticulum was defined as any significant radio-opaque pouch branching off the detrusor muscle. VUR was defined as any reflux Grade 1 or higher.
Findings: Complete records were available for 251 urodynamic studies, of which 87 were classified as Neurogenic, 83 as Obstructive, and 81 as Incontinent. Mean compliance for all patients was 75 cc/cm H20 (range 0.3 to 400). When comparing compliance between study types, the Neurogenic group had the lowest mean compliance (55 cc/cm H20), followed by Obstructive (83 cc/cm H20), and Incontinent (87 cc/cm H20) (p <0.0001). Sixty-two (25%) studies had radiologic evidence of bladder diverticula and/or VUR. Within each study type, the Neurogenic group had significantly more diverticula/VUR than the Obstructive or Incontinence groups (30 vs. 26 vs. 6, p<0.0001). Chi square analysis revealed that any patient with a compliance < 20 cc/cm H20 had a higher risk of diverticula and/or VUR (OR 4.32, 95% CI [2.34, 8.00]).
Conclusions: Patients with low compliance bladders were over four times as likely to have radiologic evidence of bladder diverticula and/or VUR compared to high compliance patients. Fluoroscopic urodynamics should be used to detect concomitant diverticula/VUR when studying groups at risk for low compliance.


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