MP49-07 HEMI-KOCK CONTINENT STOMA WITH AUGMENTATION CYSTOPLASTY FOR NEUROGENIC LOWER URINARY TRACT DYSFUNCTION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2018MP49-07 HEMI-KOCK CONTINENT STOMA WITH AUGMENTATION CYSTOPLASTY FOR NEUROGENIC LOWER URINARY TRACT DYSFUNCTION Sender Herschorn Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1598AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of patients with neurogenic lower urinary tract dysfunction who require but cannot perform urethral intermittent (CIC) catheterization is facilitated by surgical creation of a continent abdominal access. A cohort of patients who underwent a hemi-Kock continent cutaneous bladder stoma was analyzed to assess long-term durability and the need for revisional surgery. METHODS 88 patients, 66 women and 22 men, with a mean age of 36.6 years (range 18-69) underwent the procedure, primarily for intractable urinary incontinence. Diagnoses were spinal cord injury (44), spina bifida (23), MS (6), transverse myelitis (2), other neurologic causes (16). Preoperative management consisted of foley in 58 patients, suprapubic catheter in 12, and condom or diapers with or without CIC in 18. During the surgery, in addition to the intussuscepted ileal segment continent stoma 84 patients had a cystoplasty with adjacent ileum and 4 had sigmoid cystoplasty. To address urethral incompetence, in the women, 34 had bladder neck (BN) slings, 14 had slings with BN tapering, and 9 had BN closure; in the men 9 had BN slings with tapering and 3 had BN closure. Stomal and valve revision rate, surgical re-interventions, and overall success were analyzed based on prospectively collected data. Success was defined as persistence with CIC and social continence. RESULTS Mean follow-up after original surgery was 8.6 years (range .33-27.2). All of the patients, except 2 quadriplegic females, carried out their own stomal IC. Bladder capacity increased significantly (203 cc to 433 cc) while pressure at capacity decreased from 37 cm water to 9 cm water (P<0.0001). At last follow-up, 77 (87.5%) were managing with CIC±pads. Eleven (12.5%) were failures and of these, 7 had indwelling catheters and 4 had ileal conduits. 32 patients (36%) have not required any additional surgery, 37 (42%) have had endoscopic procedures for bladder stones, 25 (12%) required open surgery including valve revision (13), BN procedures (4), ileal conduit (4), stomal hernia (2), early perforation (2). 3 patients died from unrelated causes and 1 from urothelial cancer after 15 years. 2 women had full term pregnancies. Re-interventions may be needed years after the original procedure. No other significant morbidity has been seen. CONCLUSIONS This procedure is a good option with long-term durability in patients who require a continent abdominal access to their bladders. Leaving urethral access and having a large catheterizing channel facilitates subsequent endoscopic procedures, if required. Long-term follow-up is needed. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e668-e669 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sender Herschorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...