Table 1.
Summary of the studies
| Variable | Study | |||
|---|---|---|---|---|
| Author | Stenzl et al. [11] | Stenzl and Ninkovic [14] | Ninkovic et al. [12] | Gakis et al. [13] |
| Year | 1998 | 2001 | 2003 | 2011 |
| Country | Austria | Austria | Austria | Germany |
| Study type | Case series | Case series | Case series | Case series |
| Level of evidence | IV | IV | IV | IV |
| No. of patients | 3 | 11 | 20 | 24 |
| Sex, M/F | - | 7/4 | 14/6 | 16/8 |
| Age (yr), mean (range) | 40.6 (23–68) | 42 (9–68) | 39.4 (9–68) | 39 (13–63) |
| Etiology (n) | Spinal cord injury (2); chronic overdistension (1) | Traumatic spinal cord injury (6); congenital malformation (2); idiopathic (1); chronically overdistended bladder (1) | Spinal cord injury (12); idiopathic (5); congenital (3) | Spinal cord injury (16); congenital malformation (1); idiopathic (4); chronically overdistended bladder (3) |
| Preoperative evaluation | - | - | Urodynamic assessment, cystoscopy, upper tract imaging and electro-myography of the rectus muscle | Video urodynamics, diagnostic urethra cystoscopy and excretory urography. In addition, electromyography of the lower portion of the rectus abdominis muscle |
| Operation time (min), mean ± SD | - | - | - | 536 ± 22 |
| Length of hospital stay (day), mean (range) | - | - | 10 (8–14) | 13 (7–32) |
| Postoperative evaluation | 3 Months: uroflow, assessment of voided volume and residual urine, intravenous urography, and Doppler sonography of the bladder; 6 and 12 months: urodynamic evaluation and flow-mode CT | 3 Months: measurements of uroflow, urine voiding volumes, urine, and residual, intravenous urography, and Doppler sonography of the bladder; 6 and 12 months: urodynamic evaluation and flow-mode CT | 3 Months: Doppler ultrasonography; 6 months: Doppler ultrasonography; dynamic computerized tomography; 12 months: Doppler ultrasonography; dynamic computerized tomography; excretory urography or ultrasonography; video urodynamic evaluation | 3 Months intervals for the first year: Doppler ultrasonography; 6 and 12 months: video urodynamic evaluations. |
| Urodynamics and measurement of post- void residual urine volume. Bladder contractility index was calculated. Measurement of post-void residual volume and Qmax in combination with urodynamics and upper urinary tract imaging. Self-evaluate satisfaction with postoperative outcome | ||||
| Follow-up (mo), mean (range) | 16 (12–20) | 25 (12–46) | 44 (18–74) | 46 (8–89) |
| Postoperative care (flap monitoring etc) | Permanent indwelling intramuscular pO2 probe | Permanent indwelling intramuscular pO2 probe | Intramuscular probe measuring the pO2 | Doppler ultrasonography regularly |
| Postsurgical catheterization (wk) | 16 (2 patients); 30 (1 patient) | 8–12 | 8–12 | 12 |
| Measure of follow-up | Voluntary voiding; Post-void residual volume | Voluntary voiding; Reduction in CIC; Post-void residual volume | Voluntary voiding; Post-void residual volume; Reduction in CIC | Voluntary voiding; Bladder contractility index; Post-void residual volume; Reduction in CIC |
| Clinical outcomes (complete/partial/no response) | - Complete response in all patients (able to void spontaneously with post- void residual volumes of less than 100 mL). Image: Cystourethrography: slightly irregular shape of the bladder, no reflux on emptying, and bladder evacuation almost to completion. Doppler sonography and flow-mode CT: The well-vascularized transplanted latissimus dorsi and its contractions during bladder emptying | - Complete response in 8 patients (able to void spontaneously with post-void residual volumes of less than 100 mL). | - Complete response in 14 patients (void spontaneously within 4 months postoperatively with post-void residual volumes of less than 100 mL). Voluntary voiding was restored by bladder neck incision in 4. | - Complete response in 17 patients (complete spontaneous voiding with a mean post-void residual less than 100 mL). |
| - Partial response in 2 patients (catheterizes themselves less often). | - No response in 2 patients (still require self-catheterization) Postoperative detrusor pressures ranged from 5 to 218 cm. H2O (mean 72, median 55) | - Partial response in 3 patients (frequency of CIC was reduced to 2 to 4 times daily with a mean post-void residual urine volume of 200 mL). | ||
| - No response in 1 patient (continues to require 4 to 5 catheterizations daily); Image: Voiding cystourethrography: normal or slightly irregular shaped bladders, no reflux on voiding, and bladder evacuation almost to completion among patients with voluntary voiding. Doppler sonography or flow-mode CT: LDM contractions during voiding | - No response in 4 patients. Mean bladder contractility index among complete response patients increased from 20.1 ± 7.6 to 176.2 ± 25.4 (P < 0.001) | |||
| Early postoperative complication (n) | Dislocated probe (1) | Dislocated probe (2); retroperitoneal hematoma (1); Seroma in the axillary region (1); transient unilateral loss of sensation in the upper and lower extremities (1) | Dislocated probe (2); pelvic hematoma (1); transient peroneal nerve palsy (1); seroma at the donor site (3) | |
| Late postoperative complication (n) | UTI (1) | UTI and bladder stone formation (2) | UTI (2) | UTI (21) |
M, male; F, female; CT, computed tomography; CIC, clean intermittent catheterization; LDM, latissimus dorsi muscle; UTI, urinary tract infection.