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Objectives. To describe the clinical and urodynamic features of patients with voiding dysfunction secondary to schistosomal myelopathy. Schistosomiasis mansoni is an endemic fluke infection in South America, the Caribbean, and Africa. In the United States and Europe, people may be infected mainly through travel to endemic areas and immigration of infected individuals. Clinical involvement of the spinal cord is a well-recognized complication of the disease. The typical manifestations are those of an acute transverse myelitis, with sudden onset of lower extremity neuropathy associated with bladder and bowel dysfunction. Methods. We reviewed the records and urodynamic studies of 14 consecutive patients (10 men and 4 women, age range 23 to 49 years) with schistosomal myelopathy confirmed by cerebrospinal fluid serology for S. mansoni , who were referred for evaluation of voiding dysfunction during a 2-year period. At the time of the urologic evaluation, 9 patients had chronic neurologic and urinary symptoms and 5 had recent onset of acute symptoms. The voiding function history, urologic complications, and outcomes after therapy for schistosomiasis were reviewed. Results. Of the patients with acute disease (5 patients), the urologic symptoms included urinary retention (3 patients) and incontinence (2 patients). Three of them had concurrent lower back pain and lower limb neurologic deficits. Urodynamic studies were performed in 3 patients and revealed bladder areflexia in 2 patients and detrusor hyperreflexia with external sphincter dyssynergia in 1 patient. The patients were started on clean intermittent catheterization and received praziquantel and corticosteroids. Three patients had complete resolution of their symptoms, one recovered normal voiding function but the neurologic deficits persisted, and one had no clinical improvement. All patients with chronic schistosomal myelopathy presented with lower limb neurologic deficits of varying degrees and urinary symptoms, including difficulty emptying the bladder (7 patients), urinary incontinence (6 patients), and urgency and frequency (2 patients). Laboratory and radiographic evaluation of patients with chronic disease revealed urinary tract infection in 5 patients, hydronephrosis in 2 patients, and bladder calculi in 2 patients. Urologic management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication, and stone removal, as appropriate. In 1 patient, conservative treatment failed and that patient required ileocystoplasty. Conclusions. Schistosomal myelopathy is a potential cause of severe voiding dysfunction secondary to spinal cord disease. A high index of suspicion is paramount because early medical intervention can abort the progression of neurologic deterioration.

Most groups have reported disappointing results with autoaugmentation or detrusor myectomy for low capacity/compliance neuropathic bladders. Failure may be due to an ischemic diverticulum or mucosal shrinkage. We investigated whether a Silimed® silicone balloon placed in the bladder after autoaugmentation could prevent these problems, improving surgical results.We compared the results of standard bladder autoaugmentation in 12 children (group 1) with those in 10 (group 2) who underwent the same surgery using a bladder conformer. The conformer was a silicone balloon filled with saline that remained in the bladder for 2 weeks. All patients had a neuropathic bladder with poor capacity and compliance, resulting in urinary leakage between catheterizations. Preoperative and postoperative evaluation included a voiding diary, ultrasound, voiding cystourethrogram and urodynamics.In group 1 only 1 patient became dry, 4 had little improvement in continence, 4 remained unchanged and 3 became worse. In group 2, 6 patients (60%) become continent without medication, 2 (20%) become continent with oxybutynin and 2 remained unchanged. Bladder capacity and compliance did not change significantly in group 1. However, in group 2 capacity changed from a mean of 140 to 240 ml and mean ± SD compliance increased from 15.6 ± 16.8 to 34.3 ± 22.8 ml/cm H(2)O (p = 0.02).The inflatable balloon improved our long-term results of bladder auto-augmentation. A larger series may be necessary to confirm procedure efficacy and safety.

Purpose To present the long-term RESULTS of bladder autoaugmentation in children with low compliant neurogenic bladders comparing the usual technique with a modified technique using an intra vesical silicon inflatable balloon device. Material and Methods Twenty-two patients with low-compliant neurogenic bladders and incontinence confirmed urodynamically were divided in two groups. Group I (12 patients) underwent autoaugmentation using the classical detrusorectomy approach. Group II (10 patients) underwent autoaugmentation associated to an intra vesical silicon inflatable device filled with saline solution customized to allow urine elimination and sustain partial bladder distention. Results Follow up ranged from 2 to 11 years (mean 4 years). Patients in Group I showed unsatisfactory RESULTS, with only one patient achieving continence using clean intermittent catheterization (CIC). Four patients showed mild improve on urodynamic parameters. Patients in group II showed encouraging RESULTS. Six patients achieved continence with CIC. Two patients achieved continence using CIC and anticholinergic agents. Bladder capacity had a mean increase of approximately 71% and bladder compliance mean increased from 15.6 ± 16.8 ml/cmH2O to 34.3 ± 22.8 ml/cmH2O (p = 0.02). Two patients with previously dilated upper urinary tract showed a decrease in the grade of dilatation. Conclusions Bladder autoaugmentation using an intra vesical silicon inflatable balloon device showed better RESULTS compared to the usual autoaugmentation technique. The presented device didn't add morbidity to the surgical procedure. This technique can be used in selected patients in order to improve urodynamic parameters and continence without the potential disadvantages of using bowel segments for bladder augmentation.

OBJECTIVE To describe the clinical and urodynamic features of patients with chronic voiding dysfunction secondary to schistosomal myeloradiculopathy (SM), as the clinical involvement of the spinal cord is a well recognized complication of Schistosomiasis mansoni infection. PATIENTS AND METHODS We reviewed the records and urodynamic studies of 26 consecutive patients (17 males and nine females, aged 8–58 years) with chronic neurological and urinary symptoms secondary to SM. The voiding function history, radiological and urodynamic findings and therapeutic approaches were reviewed. Patients with and without upper urinary tract complications were compared in terms of age, duration of voiding dysfunction and urodynamic pattern. RESULTS The most common urinary symptoms were difficulty in emptying the bladder (17 patients, 65%), urinary incontinence (14, 54%), and urgency and frequency (13, 50%). Laboratory and radiographic evaluation showed urinary tract infection in eight (30%) patients, bilateral hydronephrosis in five (19%) and bladder calculi in five (19%). Urodynamics showed detrusor overactivity with detrusor-external sphincter dyssynergia (DESD) in 14 patients (54%), detrusor arreflexia in six (23%), detrusor overactivity with no dyssynergia in four (15%), and detrusor underactivity in two (8%). Comparing patients with and without upper tract complications showed no differences in age and duration of urinary symptoms, but there was a significant association of detrusor overactivity with DESD and upper urinary tract complications (P = 0.04). Urological management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication and stone removal, as appropriate. Conservative treatment failed in three patients and they required an injection with botulinum-A toxin into the detrusor (two) or ileocystoplasty (one). CONCLUSION Patients with chronic SM behave clinically like those with other causes of spinal cord disease and neurogenic bladder dysfunction requiring lifelong surveillance. The severity of illness in these patients should re-emphasize the need for early recognition and treatment of this condition, to prevent or reverse the neurological deficits.

Surgical correction of penile curvature due to Peyronie's disease was done using the Nesbit operation originally described for repair of congenital curvatures. A modification of the technique was introduced using a skin incision over the local area where the ellipse was taken thereby avoiding unnecessary extended dissection. The results in 22 patients were satisfactory with minimal surgical complications. Good results, short-term hospitalization and simplicity of the technique make this approach the first to be considered in cases of surgical correction of Peyronie's disease.

Thirty four patients with sacral agenesis were seen from 1954 to 1983, cases of meningomyelocele excluded. Five recognizable and consistent patterns of bone malformation were identified. Urodynamic examinations were done in 10 of the 34 patients. Their evaluation and response to treatment are analyzed; we tried to determine and establish the possible causes for its late diagnosis and consequences regarding the upper urinary tract.