Latissimus dorsi detrusor myoplasty for bladder acontractility: a systematic review

Bladder acontractility affects several thousand patients in the United States, but the available therapies are limited. Latissimus dorsi detrusor myoplasty (LDDM) is a therapeutic option that allows patients with bladder acontractility to void voluntarily. Our goal was to conduct a systematic review of the literature to determine whether LDDM is a better option than clean intermittent catheterization (CIC) (standard treatment) in patients with bladder acontractility. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases, without time frame limitations, to identify articles on the use of LDDM for bladder acontractility. Of 75 potential articles, 4 fulfilled the eligibility criteria. The use of LDDM to treat patients with bladder acontractility was reported in four case series by the same group in Europe. Fifty-eight patients were included, and no comparison groups were included. The most common cause of bladder acontractility was spinal cord injury (n=36). The mean (±standard deviation) operative time was 536 (±22) minutes, postoperative length of hospital stay ranged from 10 to 13 days, and follow-up ranged from 9 to 68 months. Most patients had complete response, were able to void voluntarily, and had post-void residual volume less than 100 mL. Although promising outcomes have been obtained, evidence is still weak regarding whether LDDM is better than CIC to avoid impairment of the urinary tract among patients with bladder acontractility. Further prospective studies with control groups are necessary.

Keywords

Urinary bladder, neurogenic - Free tissue flaps - Superficial back muscles

Publication History

Received: 05 March 2021

Accepted: 27 May 2021

Article published online:
19 March 2022

• REFERENCES

• 1 Ginsberg DA. Bladder acontractility: detrusor myoplasty and other options. Nat Rev Urol 2011; 8: 185-6
• 2 Ninkovic M, Stenzl A, Gakis G. et al. The latissimus dorsi detrusor myoplasty for functional treatment of bladder acontractility. Clin Plast Surg 2012; 39: 507-12
• 3 van Koeveringe G, Rademakers K, Stenzl A. Latissimus dorsi detrusor myoplasty to restore voiding in patients with an acontractile bladder: fact or fiction?. Curr Urol Rep 2013; 14: 426-34
• 4 de Seze M, Ruffion A, Denys P. et al. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler 2007; 13: 915-28
• 5 Sakakibara R, Uchiyama T, Yamanishi T. et al. Bladder and bowel dysfunction in Parkinson’s disease. J Neural Transm (Vienna) 2008; 115: 443-60
• 6 Tibaek S, Gard G, Klarskov P. et al. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey. Neurourol Urodyn 2008; 27: 763-71
• 7 Vaidyanathan S, Krishnan KR, Soni BM. et al. Unusual complications of intermittent self-catheterisation in spinal cord injury patients. Spinal Cord 1996; 34: 745-7
• 8 Wyndaele JJ. Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 2002; 40: 536-41
• 9 Stenzl A, Ninkovic M, Willeit J. et al. Free neurovascular transfer of latissimus dorsi muscle to the bladder. I. Experimental studies. J Urol 1997; 157: 1103-8
• 10 Ninkovic M, Stenzl A, Hess M. et al. Functional urinary bladder wall substitute using a free innervated latissimus dorsi muscle flap. Plast Reconstr Surg 1997; 100: 402-11
• 11 Stenzl A, Ninkovic M, Kolle D. et al. Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle. Lancet 1998; 351: 1483-5
• 12 Ninkovic M, Stenzl A, Schwabegger A. et al. Free neurovascular transfer of latisstmus dorsi muscle for the treatment of bladder acontractility: II. clinical results. J Urol 2003; 169: 1379-83
• 13 Gakis G, Ninkovic M, van Koeveringe GA. et al. Functional detrusor myoplasty for bladder acontractility: long-term results. J Urol 2011; 185: 593-9
• 14 Stenzl A, Ninkovic M. Restoring voluntary urinary voiding using a latissimus dorsi muscle free flap for bladder reconstruction. Microsurgery 2001; 21: 235-40
• 15 Zhang YH, Shao QA, Wang JM. Enveloping the bladder with displacement of flap of the rectus abdominis muscle for the treatment of neurogenic bladder. J Urol 1990; 144: 1194-5
• 16 Messing EM, Dibbell DG, Belzer FO. Bilateral rectus femoris pedicle flaps for detrusor augmentation in the prune belly syndrome. J Urol 1985; 134: 1202-5
• 17 Ninkovic M, Dabernig W. Flap technology for reconstructions of urogenital organs. Curr Opin Urol 2003; 13: 483-8