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When we compared baseline and follow-up UDS done 3 months after BoNTA, the vast majority of patients had an improvement in capacity, uninhibited contractions, compliance and intravesical pressure.
One of the 2 had a primary diagnosis of myelomeningocele and experienced persistent high intravesical pressure with recurrent symptomatic UTI.
Additionally, urodynamic work-up included: in cystometry: detrusor pressure at overactivity (Pdet overact), intravesical pressure at maximum cystometric capacity (Pves CC), and bladder wall compliance (Comp).
Detrusor overactivity is accompanied by dyssynergia with the striated external sphincter mechanism, leading to high intravesical pressure and incomplete bladder emptying.
Key Words: Abdominal compartment syndrome; Intra-abdominal hypertension; Children; Pediatrics; Intravesical pressure; Percutaneous decompression; Management
A sustained high intravesical pressure ([is greater than] 40 cm [H.sub.2]O) can result in vesico-ureteral reflux causing pyelonephritis and renal calculi (Perkash, 1993).
However, since CSF pressure with straining may exceed 700 mm [H.sub.2]O and intra-abdominal pressure is between 200 and 700 mm [H.sub.2]O, as measured indirectly through intravesical pressure during the second stage of labor, it seems unlikely that retrograde flow of CSF would occur since there is still a pressure difference.
During the VUDS, the 8 Fr feed tube (for filling) and transducer catheters (for measurement of intravesical pressure, called Pves) were inserted into the bladder.
In this study, detrusor activity, bladder sensation, bladder capacity, bladder compliance, urethral function, maximum bladder capacity, Pves max (maximum intravesical pressure), Pabd max (maximum abdominal pressure), and Pdet max (maximum detrusor pressure) were recorded in the filling phase.
High intravesical pressure will induce significant inflammation, followed by smooth muscle cell (SMC) hypertrophy and, finally, can progress to a fibrotic, non-compliant, hostile bladder.
In the present study intra-abdominal pressure was measured indirectly by estimating intravesical pressure through a Foley's catheter.