Latissimus dorsi detrusor myoplasty for bladder acontractility: a systematic review

Archives of Plastic Surgery, 2021 · DOI: https://doi.org/10.5999/aps.2021.00402 · Published: September 1, 2021

Simple Explanation

Bladder acontractility is a condition where the bladder cannot contract, leading to problems with urination. Current treatments are limited, often requiring patients to use catheters multiple times a day. Latissimus dorsi detrusor myoplasty (LDDM) is a surgical option that uses muscle from the back to help the bladder function. This review examines if LDDM is better than regular catheterization. The review found that while LDDM shows promise, the current evidence is weak. More studies are needed to determine if LDDM is truly better than catheterization for bladder acontractility.

Study Duration

Follow-up ranged from 9 to 68 months

Participants

58 patients with bladder acontractility

Evidence Level

Level IV, case series

Key Findings

1
The review included four case series, all from the same group in Europe, involving a total of 58 patients.
2
The most common cause of bladder acontractility in the reviewed studies was spinal cord injury.
3
Most patients in the case series were able to void voluntarily after LDDM and had reduced post-void residual volume.

Research Summary

This systematic review aimed to determine if latissimus dorsi detrusor myoplasty (LDDM) is superior to clean intermittent catheterization (CIC) for treating bladder acontractility. The review analyzed four case series, all from the same European group, involving 58 patients. The included studies reported promising outcomes with LDDM, such as improved voluntary voiding and reduced post-void residual volume. However, the absence of control groups in these studies limits the strength of the evidence. The review concludes that while LDDM shows potential, further prospective studies with control groups are necessary to definitively determine if LDDM is better than CIC for patients with bladder acontractility.

Practical Implications

Surgical Considerations

LDDM is a technically demanding procedure requiring specialized surgical teams and a significant operative time.

Patient Selection

Careful consideration should be given to patient selection for LDDM, as approximately 30% of patients may still require CIC after the procedure.

Future Research

Prospective studies with control groups, long-term follow-up, and well-defined preoperative criteria are needed to validate the effectiveness of LDDM.

Study Limitations

1
The review is limited by the small number of studies that met the inclusion criteria.
2
All included studies were case series without comparison groups, which limits the strength of the conclusions.
3
The data collection may be biased due to the nature of the included studies.

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