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UP-1.182: Bilateral Ureterocystoplasty: New Technique for Augmentation of Bladder in Transplant Patients
UNMODERATED POSTER SESSIONS
UP-1.180 Effect of Extracorporeal Magnetic Innervation Pelvic Floor Therapy (ExMI) for Urinary Incontinence after Radical Prostatectomy Kim YH, Hwang EG, Shin JH, Kim YW, Lim JS, Na YG, Song KH, Sul CK Chungnam National University Hospital, Saejon, South Korea Introduction and Objective: To evaluate the safety and clinical effects of extracorporeal magnetic innervation (ExMI) for urinary incontinence following radical prostatectomy. Material and Methods: Thirty-two patients with urinary incontinence after radical prostatectomy were randomized to receive either ExMI treatment group or pelvic floor training alone. For ExMI group, treatment was initiated one week after catheter removal and the treatment session were for 20 minutes, twice a week for 8 weeks. For the control group, only pelvic floor muscle exercises were performed. Patients were followed up for 1 week, 1, 2, 3 and 6 months. Outcomes were assessed with a 24-hour pad weight testing, the number of pads used daily, quality-of-life survey (I-QoL). Results: The leakage weight during the 24 hours after removing the catheter was 655, 646g for ExMI and control groups. At 1 month, it was 147, 187g and at 2 months was 33, 81g (p⫽0.001) and at 3 months was 9, 45g (p⫽0.001). Finally, 6 months later, leakage weight was less than 10g in both groups. The number of pads used daily after removing the catheter were 4.2, 4.1 for ExMI and control groups. At 1 month, it was 1.5, 1.8 and at 2 months was 0.6, 0.9 (p⫽0.033) and at 3 months 0.1, 0.6 (p⫽0.002). Finally, 6 month later, pads counts were 0, 0.1. IQoL score decreased after surgery, but gradually improved in both groups. No other side effects and adverse events were observed. Conclusions: ExMI provides earlier recovery of continence compared with control group after radical prostatectomy. UP-1.181 Treatment of Female Stress Urinary Incontinence after Failed Slings Leng J, Lu J, Sun K, Chen XF, Ping P Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China Introduction and Objective: To explore the causes of failed surgical procedures and salvage methods for these failed cases. Materials and Methods: Since July 2003
to May 2006, 23 female patients of stress urinary incontinence (SUI) aging from 4978(average 65⫾9.8) after failed operations were enrolled in the group. There were 2 cases (Group A) with urethral stent because of voiding difficulty after TVT, 13 cases (Group B) still with urinary incontinence after Burch colposuspension, TVT, SPARC, and 8 cases (Group C) had different degrees of SUI symptom after kinds of operations. These patients were divided into 3 groups and treated according to the degrees of severity of the symptom. Group A; 2 cases with voiding difficulty and acute urinary retention ,the treatment was urethral stent combined with urethral amplification regularly (once two weeks), physical exercise and medicine(␣-receptor blocker); Group B included 13 cases with mild, moderate, severe degrees of SUI respectively, 3 patients with mild SUI symptom were advised electrical stimulation to pelvic floor muscles combined with contracting the levator muscles, the other 10 patients with moderate, severe degrees of SUI were given TVT operation again after 3 months of conservative treatment. Group C included 8 cases with urge urinary incontinence; they were treated with anticholinergic medications combined with electrical stimulation to pelvic floor muscles. Results: Two patients in group A restored voiding after 4 and 6 weeks; the SUI symptom disappeared in 13 patients in group B, except that 2 patients suffered bladder wall puncture during the TVT operation; in group C, the symptoms of urge urinary incontinence lessened dramatically in all the cases, out of which the symptoms disappeared in 4 patients. Conclusions: We should choose different methods for SUI patients after failed surgical procedures according to their conditions. For some cases, the conservative procedures would be the first choice, if tried ineffective, then operation was suggested. Severe urge urinary incontinence was thought the relative contraindication for re-operation. UP-1.182 Bilateral Ureterocystoplasty: New Technique for Augmentation of Bladder in Transplant Patients Taghizadeh Afshari A, Bazargani T. S, Bartani Z Urmieh University of Medical Sciences, Urmieh, Iran Introduction and Objectives: Augmentation cystoplasty is well tolerated by patients with neurogenic bladder in whom conservative therapy has failed. Several
UROLOGY 74 (Supplment 4A), October 2009
tissues can be used for augmentation. An ideal tissue for increasing capacity and improving compliance would have transitional epithelium which is relatively impermeable and avoid metabolic changes. Such this alternative procedure is ureterocystoplasty. With this concept, we evaluated a kidney transplant patient with neurogenic bladder, who had recurrent UTI because of bilateral vesicoureteral reflux and needed bilateral nephrectomy. We prepared him for augmentation cystoplasty, using both ureters after bilateral nephrectomy, to reach maximum capacity and compliance (bilateral ureterocystoplasty). Materials and Method: The patient was a 17 years old male with ESRD. He had bilateral grade IV vesicoureteral reflux and a special pattern of bladder resembling a neurogenic one. The patient was planned for kidney transplantation after 9 months of dialysis. He was transplanted with a kidney from his brother. He was fine after surgery until two episodes of Pyelonephritis leading to admition. On urodynamic studies, the diagnosis of neurogenic bladder with low compliance was confirmed, and the need for augmentation cystoplasty to save the transplant. Results: The operation started with a midline incision and entering peritoneal cavity. Both kidneys were quite small and both ureters were moderately dilated and full of Pus. First, bilateral simple nephrectomy was performed. Then both dilated ureters were mobilized and opened on their anterolateral surface to the UVJ. The bladder opened in midline and bivalved, then we sewed medial edges of ureters to each other, and sutured lateral edges to bivalved bladder halves. The final result was almost dome Shaped. Suprapubic catheter was inserted through native bladder wall, and a Foley urethral catheter secured 7 days. After 3 weeks from the time of surgery, the last catheter removed after performing a cystography. Conclusion: Augmentation cystoplsty is still the best surgical method for correcting storage and emptying problems of the bladder. In patients with massive reflux to the ureter, which is draining a poorly or non-functioning kidney it is reasonable to use the ureteral tissue to augment the bladder. This will result in less metabolic changes prohibiting malignancies. In this patient, we came to a special scenario, a kidney transplanted patient with neurogenic bladder and bilateral chronic pyelonephritis, a good candidate for bilateral nephrectomy. As the ureters were moderately dilated, we planned to use both of them for ureterocystoplasty, in order to
S227
UNMODERATED POSTER SESSIONS
effectively enhance bladder volume and compliance. Short term follow up of the patient showed good bladder capacity with no leakage, and he was put on CIC. Further follow up is needed to confirm its efficacy and safety. This could be posed as a new surgical method for patients undergoing cystoplasty, which having small nondilated ureters especially if they are transplant candidates. UP-1.183 Efficacy of Repeat Intradetrusor Botulinum A Toxin Injection for Neurogenic Detrusor Overactivity Png K, Toh K Department of Urology, Tan Tock Seng Hospital, Singapore Introduction and Objective: To study the clinical and urodynamic efficacy of repeat intradetrusor botulinum A toxin injections for the treatment of neurogenic detrusor overactivity (NDO). Materials and Methods: From May 2004 to January 2009, there were a total of 13 repeat injections. Nine had at least 2 injections with 4 receiving a 3rd injection, giving a total of 22 injections. All patients were evaluated using videourodynamic study and 3-day voiding diary before the first injection. Six consented to videourodynamic studies 6 weeks after the first injection. Clinical and urodynamic parameters were compared before and after repeat injections. Results: The etiologies of NDO included 6 traumatic injuries, 1 transverse myelitis, 1 cervical myelopathy and 1 central cord edema. Median age was 57 years (range: 32-70) with male:female ratio of 2:1. There was no significant difference in the time intervals between Injections 1-2 and Injections 2-3 (476 days vs 389 days). Clinical continence improved from zero at baseline to 77.8% (95%CI 45.3%-93.7%) and 55.6% (22.7%-84.7%) after the 1st and 2nd injections respectively. Patients on anticholinergics decreased from 100% at baseline to 33.3%(95%CI 12.1%-64.6%) and 11.1%(2.0%-43.5%) respectively. All patients had NDO contractions at baseline. Of the 6 patients who had post-injection urodynamic studies, contractions were abolished in 4 patients. Leakage demonstrated reduced from 7 patients to 2 patients. Median rise in detrusor pressure decreased significantly from 60cmH2O (interquartile range 43-81cmH2O) to 9cmH2O (interquartile range 7-26cmH2O). Median reflex volume increased significantly from 120mls (interquartile range 85-185mls) to 348mls (interquartile range 188-400mls). Median cystometric capacity
S228
increased significantly from 282mls (interquartile range 220-313mls) to 376mls(interquartile range 349-400mls). There was no significant change in the median compliance (40ml/cmH2O vs 53ml/cmH2O). Conclusions: This study shows that repeat intradetrusor botulinum A toxin is still effective up to 3 injections. It is a valuable long-term treatment option for patients with neurogenic detrusor overactivity. UP-1.184 Tolterodine Improves the Compliance and Cystometric Capacity of Adult Neurogenic Bladders in Spinal Cord Injury Patients Tan Y, Toh K Tan Tock Seng Hospital, Singapore Introduction and Objective: Spinal cord injury patients often develop complications secondary to upper urinary tract deterioration. There have not been any significant studies reviewing the efficacy of tolterodine in the management of patients with adult neurogenic bladders secondary to spinal cord injury. We decided to review our urodynamic data of adult patients with neurogenic bladders with spinal cord injuries who were treated with tolterodine and oxybutynin. Materials and Methods: From our urodynamic database, 136 patients were found to have neuropathic bladders secondary to spinal cord injury. We specifically reviewed pre and post tolterodine urodynamic studies of these patients and compared them with a similar group of patients which were treated with oxybutynin. Results: Complete data sets of urodynamics, before and while on medication, were available for 18 and 10 patients treated with tolterodine and oxybutynin respectively. Mean age was 44 yrs old, mean follow-up period was 3 years and male to female ratio was 14:1. The levels of spinal cord injuries were as follows: 16 cervical cord, 9 thoracic cord and 3 lumber spine injuries. For the tolterodine group median increase in compliance was 13ml/cmH20, p 0.01 and median change of cystometric capacity was ⫹88mls, p 0.115. For the oxybutynin group, median increase in compliance was 4 ml/cmH2O, p 0.285 and median change in cystometric capacity was -5mls, p0.26. Conclusions: Although tolterodine is widely used in the management of neurogenic bladder secondary to spinal cord injuries, there is a paucity of evidence supporting its use especially in delaying worsening compliance and subsequent
upper tract complications. Our study indicates that tolterodine seems to improve compliance and cystometric capacity of patients with adult neurogenic bladder secondary to spinal cord injuries. UP-1.185 Urodynamic Comparison Between Complete and Incomplete Injury in Patients with Spinal Cord Injury: Can Urodynamic Study be Skipped in a Patient With Incomplete Injury? Jeong S, Doo S, Park H, Yoon C, Hong S, Byun S, Lee S Seoul National University Bundang Hospital, Seongnam, South Korea Introduction and Objective: In case a patient with spinal cord injury (SCI) has an incomplete injury, urodynamic study is sometimes skipped on the assumption that intra-vesical pressure is more stable and detrusor compliance is higher than patients with a complete injury. Thus, we compared the results of urodynamic study between complete and incomplete injury. Materials and Methods: Sixty-two patients, who had been diagnosed with SCI at our hospital and for whom imaging study on spinal cord and urodynamic study had been conducted, were enrolled. Urodynamic study was performed in the stabilization status after spinal shock. According to the classification of American Spinal Injury Association (ASIA), ASIA A was defined as complete injury and ASIA B-E as incomplete injury, and comparative analysis was made on involuntary detrusor contraction (IDC), detrusor leak point pressure (DLPP), detrusor external sphincter dyssynergia (DESD), maximal cystometric capacity (MCC), and compliance. Results: The average age of SCI was 36.4 years, and the average period between SCI and urodynamic study was 18.5 months. Of the patients, 21 (33.9%) had a complete injury and 41 (66.1%) had an incomplete injury. Both groups did not show a significant difference in the presence of IDC and detrusor pressure on IDC (complete group: 59.0cmH2O vs. incomplete group: 49.5cmH2O, p⬎0.05). Also, no significant difference was observed between both groups in the decrease of compliance, presence of DESD, DLPP (70.7cmH2O vs. 60.7cmH2O), and MCC (404.1cc vs. 424.5cc). Conclusion: In the comparative analysis between the complete and incomplete injury, no significant difference was observed in the urodynamic parameters causing complications on the upper urinary tract. Therefore, it is considered necessary to assess bladder status using uro-
UROLOGY 74 (Supplment 4A), October 2009
UP-1.180 Effect of Extracorporeal Magnetic Innervation Pelvic Floor Therapy (ExMI) for Urinary Incontinence after Radical Prostatectomy Kim YH, Hwang EG, Shin JH, Kim YW, Lim JS, Na YG, Song KH, Sul CK Chungnam National University Hospital, Saejon, South Korea Introduction and Objective: To evaluate the safety and clinical effects of extracorporeal magnetic innervation (ExMI) for urinary incontinence following radical prostatectomy. Material and Methods: Thirty-two patients with urinary incontinence after radical prostatectomy were randomized to receive either ExMI treatment group or pelvic floor training alone. For ExMI group, treatment was initiated one week after catheter removal and the treatment session were for 20 minutes, twice a week for 8 weeks. For the control group, only pelvic floor muscle exercises were performed. Patients were followed up for 1 week, 1, 2, 3 and 6 months. Outcomes were assessed with a 24-hour pad weight testing, the number of pads used daily, quality-of-life survey (I-QoL). Results: The leakage weight during the 24 hours after removing the catheter was 655, 646g for ExMI and control groups. At 1 month, it was 147, 187g and at 2 months was 33, 81g (p⫽0.001) and at 3 months was 9, 45g (p⫽0.001). Finally, 6 months later, leakage weight was less than 10g in both groups. The number of pads used daily after removing the catheter were 4.2, 4.1 for ExMI and control groups. At 1 month, it was 1.5, 1.8 and at 2 months was 0.6, 0.9 (p⫽0.033) and at 3 months 0.1, 0.6 (p⫽0.002). Finally, 6 month later, pads counts were 0, 0.1. IQoL score decreased after surgery, but gradually improved in both groups. No other side effects and adverse events were observed. Conclusions: ExMI provides earlier recovery of continence compared with control group after radical prostatectomy. UP-1.181 Treatment of Female Stress Urinary Incontinence after Failed Slings Leng J, Lu J, Sun K, Chen XF, Ping P Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China Introduction and Objective: To explore the causes of failed surgical procedures and salvage methods for these failed cases. Materials and Methods: Since July 2003
to May 2006, 23 female patients of stress urinary incontinence (SUI) aging from 4978(average 65⫾9.8) after failed operations were enrolled in the group. There were 2 cases (Group A) with urethral stent because of voiding difficulty after TVT, 13 cases (Group B) still with urinary incontinence after Burch colposuspension, TVT, SPARC, and 8 cases (Group C) had different degrees of SUI symptom after kinds of operations. These patients were divided into 3 groups and treated according to the degrees of severity of the symptom. Group A; 2 cases with voiding difficulty and acute urinary retention ,the treatment was urethral stent combined with urethral amplification regularly (once two weeks), physical exercise and medicine(␣-receptor blocker); Group B included 13 cases with mild, moderate, severe degrees of SUI respectively, 3 patients with mild SUI symptom were advised electrical stimulation to pelvic floor muscles combined with contracting the levator muscles, the other 10 patients with moderate, severe degrees of SUI were given TVT operation again after 3 months of conservative treatment. Group C included 8 cases with urge urinary incontinence; they were treated with anticholinergic medications combined with electrical stimulation to pelvic floor muscles. Results: Two patients in group A restored voiding after 4 and 6 weeks; the SUI symptom disappeared in 13 patients in group B, except that 2 patients suffered bladder wall puncture during the TVT operation; in group C, the symptoms of urge urinary incontinence lessened dramatically in all the cases, out of which the symptoms disappeared in 4 patients. Conclusions: We should choose different methods for SUI patients after failed surgical procedures according to their conditions. For some cases, the conservative procedures would be the first choice, if tried ineffective, then operation was suggested. Severe urge urinary incontinence was thought the relative contraindication for re-operation. UP-1.182 Bilateral Ureterocystoplasty: New Technique for Augmentation of Bladder in Transplant Patients Taghizadeh Afshari A, Bazargani T. S, Bartani Z Urmieh University of Medical Sciences, Urmieh, Iran Introduction and Objectives: Augmentation cystoplasty is well tolerated by patients with neurogenic bladder in whom conservative therapy has failed. Several
UROLOGY 74 (Supplment 4A), October 2009
tissues can be used for augmentation. An ideal tissue for increasing capacity and improving compliance would have transitional epithelium which is relatively impermeable and avoid metabolic changes. Such this alternative procedure is ureterocystoplasty. With this concept, we evaluated a kidney transplant patient with neurogenic bladder, who had recurrent UTI because of bilateral vesicoureteral reflux and needed bilateral nephrectomy. We prepared him for augmentation cystoplasty, using both ureters after bilateral nephrectomy, to reach maximum capacity and compliance (bilateral ureterocystoplasty). Materials and Method: The patient was a 17 years old male with ESRD. He had bilateral grade IV vesicoureteral reflux and a special pattern of bladder resembling a neurogenic one. The patient was planned for kidney transplantation after 9 months of dialysis. He was transplanted with a kidney from his brother. He was fine after surgery until two episodes of Pyelonephritis leading to admition. On urodynamic studies, the diagnosis of neurogenic bladder with low compliance was confirmed, and the need for augmentation cystoplasty to save the transplant. Results: The operation started with a midline incision and entering peritoneal cavity. Both kidneys were quite small and both ureters were moderately dilated and full of Pus. First, bilateral simple nephrectomy was performed. Then both dilated ureters were mobilized and opened on their anterolateral surface to the UVJ. The bladder opened in midline and bivalved, then we sewed medial edges of ureters to each other, and sutured lateral edges to bivalved bladder halves. The final result was almost dome Shaped. Suprapubic catheter was inserted through native bladder wall, and a Foley urethral catheter secured 7 days. After 3 weeks from the time of surgery, the last catheter removed after performing a cystography. Conclusion: Augmentation cystoplsty is still the best surgical method for correcting storage and emptying problems of the bladder. In patients with massive reflux to the ureter, which is draining a poorly or non-functioning kidney it is reasonable to use the ureteral tissue to augment the bladder. This will result in less metabolic changes prohibiting malignancies. In this patient, we came to a special scenario, a kidney transplanted patient with neurogenic bladder and bilateral chronic pyelonephritis, a good candidate for bilateral nephrectomy. As the ureters were moderately dilated, we planned to use both of them for ureterocystoplasty, in order to
S227
UNMODERATED POSTER SESSIONS
effectively enhance bladder volume and compliance. Short term follow up of the patient showed good bladder capacity with no leakage, and he was put on CIC. Further follow up is needed to confirm its efficacy and safety. This could be posed as a new surgical method for patients undergoing cystoplasty, which having small nondilated ureters especially if they are transplant candidates. UP-1.183 Efficacy of Repeat Intradetrusor Botulinum A Toxin Injection for Neurogenic Detrusor Overactivity Png K, Toh K Department of Urology, Tan Tock Seng Hospital, Singapore Introduction and Objective: To study the clinical and urodynamic efficacy of repeat intradetrusor botulinum A toxin injections for the treatment of neurogenic detrusor overactivity (NDO). Materials and Methods: From May 2004 to January 2009, there were a total of 13 repeat injections. Nine had at least 2 injections with 4 receiving a 3rd injection, giving a total of 22 injections. All patients were evaluated using videourodynamic study and 3-day voiding diary before the first injection. Six consented to videourodynamic studies 6 weeks after the first injection. Clinical and urodynamic parameters were compared before and after repeat injections. Results: The etiologies of NDO included 6 traumatic injuries, 1 transverse myelitis, 1 cervical myelopathy and 1 central cord edema. Median age was 57 years (range: 32-70) with male:female ratio of 2:1. There was no significant difference in the time intervals between Injections 1-2 and Injections 2-3 (476 days vs 389 days). Clinical continence improved from zero at baseline to 77.8% (95%CI 45.3%-93.7%) and 55.6% (22.7%-84.7%) after the 1st and 2nd injections respectively. Patients on anticholinergics decreased from 100% at baseline to 33.3%(95%CI 12.1%-64.6%) and 11.1%(2.0%-43.5%) respectively. All patients had NDO contractions at baseline. Of the 6 patients who had post-injection urodynamic studies, contractions were abolished in 4 patients. Leakage demonstrated reduced from 7 patients to 2 patients. Median rise in detrusor pressure decreased significantly from 60cmH2O (interquartile range 43-81cmH2O) to 9cmH2O (interquartile range 7-26cmH2O). Median reflex volume increased significantly from 120mls (interquartile range 85-185mls) to 348mls (interquartile range 188-400mls). Median cystometric capacity
S228
increased significantly from 282mls (interquartile range 220-313mls) to 376mls(interquartile range 349-400mls). There was no significant change in the median compliance (40ml/cmH2O vs 53ml/cmH2O). Conclusions: This study shows that repeat intradetrusor botulinum A toxin is still effective up to 3 injections. It is a valuable long-term treatment option for patients with neurogenic detrusor overactivity. UP-1.184 Tolterodine Improves the Compliance and Cystometric Capacity of Adult Neurogenic Bladders in Spinal Cord Injury Patients Tan Y, Toh K Tan Tock Seng Hospital, Singapore Introduction and Objective: Spinal cord injury patients often develop complications secondary to upper urinary tract deterioration. There have not been any significant studies reviewing the efficacy of tolterodine in the management of patients with adult neurogenic bladders secondary to spinal cord injury. We decided to review our urodynamic data of adult patients with neurogenic bladders with spinal cord injuries who were treated with tolterodine and oxybutynin. Materials and Methods: From our urodynamic database, 136 patients were found to have neuropathic bladders secondary to spinal cord injury. We specifically reviewed pre and post tolterodine urodynamic studies of these patients and compared them with a similar group of patients which were treated with oxybutynin. Results: Complete data sets of urodynamics, before and while on medication, were available for 18 and 10 patients treated with tolterodine and oxybutynin respectively. Mean age was 44 yrs old, mean follow-up period was 3 years and male to female ratio was 14:1. The levels of spinal cord injuries were as follows: 16 cervical cord, 9 thoracic cord and 3 lumber spine injuries. For the tolterodine group median increase in compliance was 13ml/cmH20, p 0.01 and median change of cystometric capacity was ⫹88mls, p 0.115. For the oxybutynin group, median increase in compliance was 4 ml/cmH2O, p 0.285 and median change in cystometric capacity was -5mls, p0.26. Conclusions: Although tolterodine is widely used in the management of neurogenic bladder secondary to spinal cord injuries, there is a paucity of evidence supporting its use especially in delaying worsening compliance and subsequent
upper tract complications. Our study indicates that tolterodine seems to improve compliance and cystometric capacity of patients with adult neurogenic bladder secondary to spinal cord injuries. UP-1.185 Urodynamic Comparison Between Complete and Incomplete Injury in Patients with Spinal Cord Injury: Can Urodynamic Study be Skipped in a Patient With Incomplete Injury? Jeong S, Doo S, Park H, Yoon C, Hong S, Byun S, Lee S Seoul National University Bundang Hospital, Seongnam, South Korea Introduction and Objective: In case a patient with spinal cord injury (SCI) has an incomplete injury, urodynamic study is sometimes skipped on the assumption that intra-vesical pressure is more stable and detrusor compliance is higher than patients with a complete injury. Thus, we compared the results of urodynamic study between complete and incomplete injury. Materials and Methods: Sixty-two patients, who had been diagnosed with SCI at our hospital and for whom imaging study on spinal cord and urodynamic study had been conducted, were enrolled. Urodynamic study was performed in the stabilization status after spinal shock. According to the classification of American Spinal Injury Association (ASIA), ASIA A was defined as complete injury and ASIA B-E as incomplete injury, and comparative analysis was made on involuntary detrusor contraction (IDC), detrusor leak point pressure (DLPP), detrusor external sphincter dyssynergia (DESD), maximal cystometric capacity (MCC), and compliance. Results: The average age of SCI was 36.4 years, and the average period between SCI and urodynamic study was 18.5 months. Of the patients, 21 (33.9%) had a complete injury and 41 (66.1%) had an incomplete injury. Both groups did not show a significant difference in the presence of IDC and detrusor pressure on IDC (complete group: 59.0cmH2O vs. incomplete group: 49.5cmH2O, p⬎0.05). Also, no significant difference was observed between both groups in the decrease of compliance, presence of DESD, DLPP (70.7cmH2O vs. 60.7cmH2O), and MCC (404.1cc vs. 424.5cc). Conclusion: In the comparative analysis between the complete and incomplete injury, no significant difference was observed in the urodynamic parameters causing complications on the upper urinary tract. Therefore, it is considered necessary to assess bladder status using uro-
UROLOGY 74 (Supplment 4A), October 2009