Devastated bladder outlet-suprapubic catheter vs. reconstruction

Abstract

The combination of asevere urethral sphincter defect with simultaneous development of recurrent bladder outlet obstruction characterizes a"devastated bladder outlet", which often is not surgically reconstructable. Clinically, quality of life is considerably compromised in affected patients with awide variance of symptoms, mostly complete incontinence, but also urinary retention. This condition is usually preceded by multiple endoscopic interventions or even open surgical procedures, occasionally also in combination with radiotherapy of the pelvic region as part of multimodal oncological therapy. Treatment of these cases is complex and limited to few promising procedures. Apotential therapy should primarily include the decision about the possibility of preserving the urinary bladder. In individual cases, this can result in simple therapy options while at the same time maintaining an acceptable quality of life for those affected. If there is no possibility of arefunctionalization of the original bladder, supravesical urinary diversion is indicated as alast-resort therapy. This paper provides a review as well as the limits and possibilities of conservative and surgical treatment options for adevastated bladder outlet.