1169 A UNIQUE MODIFICATION TO AUGMENTATION CYSTOPLASTY WITH CATHETERIZABLE STOMA FOR NEUROGENIC PATIENTS TECHNIQUE AND LONG TERM RESULTS

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121169 A UNIQUE MODIFICATION TO AUGMENTATION CYSTOPLASTY WITH CATHETERIZABLE STOMA FOR NEUROGENIC PATIENTS TECHNIQUE AND LONG TERM RESULTS Judy Choi, Joceline Liu, Rose Khavari, Timothy Boone, and Sophie Fletcher Judy ChoiJudy Choi Houston, TX More articles by this author , Joceline LiuJoceline Liu Chicago, IL More articles by this author , Rose KhavariRose Khavari Houston, TX More articles by this author , Timothy BooneTimothy Boone Houston, TX More articles by this author , and Sophie FletcherSophie Fletcher Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurogenic bladder (NGB) with incontinence can be devastating for patients with neurologic illness. Augmentation cystoplasty with a continent catheterizable stoma creates a continent, low pressure storage system, with an easily catheterizable cutaneous stoma leading to both decreased urinary tract morbidity and increased quality of life. This study evaluates the use of a novel procedure, the ileocecal augmentation cystoplasty for patients with NGB. METHODS Retrospective chart review of modified Indiana augment procedures by a single surgeon between 1993 and 2009 was performed. Subjects with NGB and minimum 1-yr follow up were included. All patients underwent the modified Indiana continent urinary reservoir procedure in which the large bowel portion of the ileocecal segment is used to augment the native bladder. The efferent limb is tapered and the ileocecal valve is reinforced to form the continent catheterizable cutaneous stoma. Patient demographics, neurologic illness, NGB diagnosis, surgery details, concurrent operations, complications, estimated blood loss, continence outcomes and long term complications were recorded. RESULTS Fifty eight patients underwent Indiana augment, 35 met inclusion criteria. Mean age at time of surgery was 39.8 (SD 12.8) years. Neurologic diagnoses included MS (n=12), spina bifida (n=9), and spinal cord injury (n=14). Urodynamic findings were: decreased capacity (n=4), decreased compliance (n=4), detrusor external sphincter dyssynergia (n=5), detrusor overactivity with incontinence (n=3), hypocontractility (n=5), or combination (n=14). Concurrent surgeries included: bladder neck closure (n=3), pubovaginal sling (n=4), hysterectomy (n=3), artificial urinary sphincter (n=1), and cystolithotomy (n=1). Mean estimated blood loss was 253.6 mL (SD 136.5). There were no intra operative complications. Short term complications were: prolonged ileus (n=1), wound infection (n=1), low hematocrit requiring transfusion (n=1). Median follow up was 31 months. Long term complications occurred in 10 (29%) patients: recurrent cystitis (n=4), bladder stones (n=2), SBO (n=1) and stomal revision (n=3). All patients were continent at latest follow up. CONCLUSIONS This unique modification of the Indiana continent urinary reservoir is an excellent surgical option providing a low-pressure reservoir with a reliable continence mechanism and easily catheterizable stoma with few complications or need for reoperation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e474 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Judy Choi Houston, TX More articles by this author Joceline Liu Chicago, IL More articles by this author Rose Khavari Houston, TX More articles by this author Timothy Boone Houston, TX More articles by this author Sophie Fletcher Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...