MP5-15 MAINTENANCE OF CONTINENCE WITH RIGID ENDOSCOPIC PROCEDURES IN CONTINENT CUTANEOUS URINARY DIVERSIONS

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-15 MAINTENANCE OF CONTINENCE WITH RIGID ENDOSCOPIC PROCEDURES IN CONTINENT CUTANEOUS URINARY DIVERSIONS Charles Metcalfe, Jeffery Loh-Doyle, Sameer Chopra, Wesley Yip, Vannita Simma-Chiang, and Matthew Dunn Charles MetcalfeCharles Metcalfe More articles by this author , Jeffery Loh-DoyleJeffery Loh-Doyle More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Wesley YipWesley Yip More articles by this author , Vannita Simma-ChiangVannita Simma-Chiang More articles by this author , and Matthew DunnMatthew Dunn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.398AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is concern that using rigid endoscopes through the stoma of a continent cutaneous urinary diversion damages the continence mechanism. We report the largest and longest series to date from a single institution demonstrating the safety of trans-stomal rigid endoscopy. METHODS We performed an IRB approved retrospective review of a prospectively accrued database of all patients with urinary diversions that underwent rigid endoscopic procedures for various reasons between 2000-2013. Pre and postoperative continence, difficulty with catheterization, and need for surgical revision post procedure were evaluated. RESULTS From 2000-2013, seventy-one patients with continent cutaneous diversions underwent 191 endoscopic procedures by a single surgeon. Mean follow up was 603 days (33 days - 6.3 years). Mean age was 58.4 (38-94 years) and 58% were female. The mean number of procedures per patient was 2.7 (1-7). All procedures were performed by gaining access through the stoma with an offset rigid nephroscope and a 24-28Fr access sheath. The majority of indications for treatment included afferent valve stenosis and pouch calculi. Two patients reported continence issues post operatively; one patient was treated conservatively by way of indwelling catheter for one week and the continence returned completely. The second patient had small volume incontinence pre-operatively which worsened postoperatively. The procedure uncovered an already existent pouch-cutaneous fistula, which was revised surgically and resolved the incontinence. Patients with repeated procedures were not found to be at any higher risk of incontinence. There were no patients that had difficulty with catheterization post operatively. No surgical revisions were required for worsened continence post operatively except for the patient. CONCLUSIONS Trans-stomal rigid endoscopic procedures do not negatively affect the continence mechanism in continent cutaneous urinary diversions. Trans-stomal rigid endoscopy allows for safe endoscopic access in this difficult to treat patient population. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e87 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Charles Metcalfe More articles by this author Jeffery Loh-Doyle More articles by this author Sameer Chopra More articles by this author Wesley Yip More articles by this author Vannita Simma-Chiang More articles by this author Matthew Dunn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...