Functional Outcomes After Management of End-stage Neurological Bladder Dysfunction With Ileal Conduit in a Multiple Sclerosis Population: A Monocentric Experience

Abstract

To assess the outcome of cutaneous noncontinent urinary diversion (CNCUD) for neurogenic bladder management in multiple sclerosis (MS) patients. We retrospectively reviewed the charts of our MS patients who underwent surgery for CNCUD between 1994 and 2009. To assess the impact of urinary problems on health-related quality of life (HRQOL), a Qualiveen questionnaire was completed by the patients (scale 0 = no impact of urinary problems and 4 = high adverse impact). Overall, 53 patients with a median age of 51 years were included in the study. The mean Expanded Disability Status Scale score before surgery was 7.48 ±1.02 (range 6.5-9). The mean duration of follow-up was 73 months (range 6-168). The complication rate was 55%. Minor postoperative complications (Clavien grades I-II) occurred in 23 cases, and major complications (Clavien grades III-IV) occurred in 6 cases. The mean creatinine levels before surgery and at the last follow-up were 0.63 ± 0.2 mg/dL and 0.73 ± 0.53 mg/dL, respectively. The mean overall HRQOL scores before surgery and at last follow-up, and which assess the impact of the urinary problems on the patient, were 2.1 ± 1.18 and 1.16 ± 0.63 (P = .02), respectively. Cystectomy and CNCUD are indicated in MS-impaired patients who are refractory to medical treatment and they can result in disappearance of neurological bladder symptoms. CNCUD appears to be the procedure of choice to improve the quality of life of selected patients, despite the fact that it is associated with high perioperative morbidity.