Long‐term complications of continent cutaneous urinary diversion in adult spinal cord injured patients

Abstract

To report the long-term complications of continent cutaneous urinary diversion(CCUD) in spinal cord injured(SCI) patients unable to perform intermittent self-catheterization(ISC) through the urethra. Between July 2001 and January 2012, adult SCI patients with a neurogenic bladder who underwent CCUD according to Mitrofanoff's/Monti's/Casale's principle were enrolled. A concomitant supratrigonal and augmentation enterocystoplasty were performed because of refractory detrusor overactivity or low bladder compliance. Early postoperative complications were reported according to Clavien-Dindo classification. Long-term complications, stomal and urethral continence, renal function, urodynamic parameters and quality-of-life were assessed. Overall, 29 consecutive SCI patients were included, median age 35 years (IQR 26-46). Median follow-up time was 66 months (IQR 50-80). Two post-operative severe complications (grade III-IV) were reported. One patient had a stomal stenosis and another patient a tube stenosis. Both were treated by dilation. Two patients developed fistulae between the tube and the skin and required a surgical treatment. Three patients had bladder stones managed with endoscopy. Two patients had remnant stress urine leakage through the urethra, which was treated surgically: one received periurethral balloons(ACTTM ) and one a tension-free vaginal tape. Creatinine clearance remained stable postoperatively. Urodynamic parameters were significantly improved. At last follow-up, 100% of patients had a catheterizable continent stoma and urethral continence was achieved in 96%. An improvement of quality-of-life was reported by 90% of patients. CCUD allowed these patients to keep ISC as a voiding pattern and to be continent without any appliance. The main complications were related to the tube and to bladder enlargement; thus, annual monitoring is required. Neurourol. Urodynam. 35:1046-1050, 2016. © 2015 Wiley Periodicals, Inc.