Intractable Urinary Incontinence Research Articles

PD41-11 PERINEAL URETHRAL CLOSURE AS SALVAGE OPTION FOR PATIENTS WITH FAILED INCONTINENCE SURGERY

INTRODUCTION AND OBJECTIVE:Bladder neck closure (BNC) is a salvage option for patients with intractable urinary incontinence, irreparable urethral erosion or stricture disease. The widely establish...

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

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 ...

Urinary Retention: Catheter Drainage Bag or Catheter Valve?

The management of patients with intractable urinary incontinence presents as a challenging priority in the ageing population. To preserve the antibacterial mechanisms of the bladder, a urine collection that enables the bladder to fill and empty regularly and completely, should be used. This mimics the action of the healthy bladder. We compared the success rates of two widely used urinary-collection systems (catheter with drainage bag or a catheter valve) at our institution for those patients undergoing a trial of void.

Long-Term Outcome of the Pippi Salle Procedure for Intractable Urinary Incontinence in Patients with Severe Intrinsic Urethral Sphincter Deficiency

We evaluated the long-term outcome of the Pippi Salle procedure in patients with severe intrinsic urethral sphincter deficiency. We performed the Pippi Salle procedure in 6 males and 6 females with severe intrinsic sphincter deficiency between March 2003 and August 2013. Median patient age was 15 years (range 6 to 45). Mean followup was 75 months (range 17 to 142). Six males and 3 females had neurogenic intrinsic sphincter deficiency (spina bifida in 8 and spinal cord injury in 1). Three females had anatomical intrinsic sphincter deficiency (idiopathic bladder hypoplasia in 2 and pseudo-ureterocele in 1). Four patients had previously undergone bladder neck surgery, 3 had been treated with endoscopic injection of collagen, 2had undergone fascial sling and 1 had been treated with tension-free vaginal tape surgery. The Pippi Salle procedure was performed alone (2 patients), or in combination with bladder augmentation (4) or catheterizable abdominal stoma (1), or both (5). Complete dryness was achieved in 7 patients (58%). Of 9 patients with neurogenic intrinsic sphincter deficiency 7 (78%) achieved complete dryness. Eight patients experienced complications, including continued urinary incontinence (5), difficulty catheterizing per urethra (3) and urinary calculi (1). These 8patients were successfully treated with additional endoscopic interventions, including injection of collagen in 4, injection of dextranomer-hyaluronic acid in 1,transurethral incision of urethral kink in 3 and vesicolithotripsy in 1. After these simple interventions complete dryness was achieved in all 12 patients. Although we experienced some minor complications in the short term, most patients were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.

A guideline for the management of bladder dysfunction in Parkinson's disease and other gait disorders.

Parkinson's disease (PD) is a common neurodegenerative disorder, and lower urinary tract (LUT) dysfunction is one of the most common autonomic disorders with an estimated incidence rate of 27-80%. Studies have shown that bladder dysfunction significantly influences quality-of-life (QOL) measures, early institutionalisation, and health economics. We review the pathophysiology of bladder dysfunction in PD, lower urinary tract symptoms (LUTS), objective assessment, and treatment options. In patients with PD, disruption of the dopamine D1-GABAergic direct pathway may lead to LUTS. Overactive bladder (OAB) is the most common LUT symptom in PD patients, and an objective assessment using urodynamics commonly shows detrusor overactivity (DO) in these patients. The post-void residual (PVR) volume is minimal in PD, which differs significantly from multiple system atrophy (MSA) patients who have a more progressive disease that leads to urinary retention. However, subclinical detrusor weakness during voiding may also occur in PD. Regarding bladder management, there are no large, double-blind, prospective studies in this area. It is well recognised that dopaminergic drugs can improve or worsen LUTS in PD patients. Therefore, an add-on therapy with anticholinergics is required. Beta-3 adrenergic agonists are a potential treatment option because there are little to no central cognitive events. Newer interventions, such as deep brain stimulation (DBS), are expected to improve bladder dysfunction in PD. Botulinum toxin injections can be used to treat intractable urinary incontinence in PD. Transurethral resection of the prostate gland (TURP) for comorbid BPH in PD is now recognised to be not contraindicated if MSA is excluded. Collaboration of urologists with neurologists is highly recommended to maximise a patients' bladder-associated QOL. Neurourol. Urodynam. 35:551-563, 2016. © 2015 Wiley Periodicals, Inc.

Simultaneous Augmentation Cystoplasty and Cuff Only Artificial Urinary Sphincter in Children and Young Adults with Neurogenic Urinary Incontinence

We review our experience with artificial urinary sphincter and augmentation cystoplasty in patients with neurogenic bladder. This is the largest known series to specifically evaluate cuff only artificial urinary sphincter at augmentation cystoplasty. A total of 18 males underwent simultaneous artificial urinary sphincter and augmentation cystoplasty at our institution between 1982 and 2012, of whom 13 (72%) underwent cuff only artificial urinary sphincter. Outcomes included urinary continence, emptying modality, artificial urinary sphincter status, complications and additional procedures. Of the patients undergoing augmentation cystoplasty and cuff only artificial urinary sphincter 10 (77%) were initially continent. Average time of continence was 52.9 months. Four patients (31%) required no additional procedures and remained continent. Urinary incontinence developed in 3 patients (23%) immediately postoperatively and in 6 (46%) subsequently. Ultimately 9 patients (69%) required conversion to complete artificial urinary sphincter at a mean of 36.9 months postoperatively. Overall 12 patients (92%) were continent at followup. There were no artificial sphincter specific complications in patients undergoing the cuff only procedure with conversion to complete artificial urinary sphincter. After conversion to complete artificial urinary sphincter 3 patients (23%) experienced artificial sphincter specific complications. Reoperation was performed in 10 patients (77%), for 13 total procedures (1.3 per patient). There were no complications with cuff only artificial urinary sphincter and 6 complications with complete artificial urinary sphincter (p = 0.025). Finally, patients undergoing cuff only artificial urinary sphincter requiring revision were younger than those not requiring revision (15.6 vs 30.8 years, p = 0.026). Simultaneous cuff only artificial urinary sphincter and augmentation cystoplasty appears safe and efficacious in patients with neurogenic bladder, with fewer complications than complete artificial urinary sphincter, and may provide definitive urinary continence in up to a third of patients. This procedure is technically easy, allows for outpatient revision, provides time for the child to mature and may be cost effective in avoiding placement of additional components in this select patient population.

Pyocystis After Urinary Diversion for Incontinence – Is a Concomitant Cystectomy Necessary?

To review the incidence of defunctionalized bladder-related complications in patients who have had a supravesical urinary diversion for intractable urinary incontinence without concomitant cystectomy. We retrospectively analyzed the records of patients requiring urinary diversion for intractable urinary incontinence from 1996 to 2011 at our institution. Patients were excluded from the cohort if they had evidence of bladder outlet obstruction or a cystectomy at time of diversion, or had been diverted for active malignancy. Sixty patients underwent a supravesical urinary diversion without concomitant cystectomy for intractable urinary incontinence. The etiology of the urinary incontinence was overtly neurogenic in 28 patients and non-neurogenic in 32 patients. Patients had an average follow-up of 45 months (range, 9-96). The indications for surgery, previous surgical interventions, complications of surgery, and long-term outcomes, including the incidence of pyocystis and the need for secondary cystectomy in the postoperative period were reviewed. Four of 60 patients (7%) experienced complications relating to the defunctionalized bladder; this included pelvic pain and pyocystis. Only 1 patient required admission to hospital for treatment of pyocystis, the remaining 3 patients were successfully managed as outpatients with oral antibiotics or analgesics. No patient required a secondary surgical procedure for the defunctionalized bladder. Pyocystis and the need for a secondary cystectomy were rare complications in this cohort; we therefore believe that a concomitant cystectomy is unnecessary in patients undergoing supravesical urinary diversion for intractable urinary incontinence.

5．尿失禁に対する再生医療―高年齢，難治性腹圧性尿失禁症例への応用―

5．尿失禁に対する再生医療―高年齢，難治性腹圧性尿失禁症例への応用―

VID-08.09 Laparoscopic Ileal Conduit: An Intracorporeal Uretero-ileal Anastomotic Technique

Laparoscopic ileal conduit urinary diversion is an accepted treatment option for patients with intractable urinary incontinence following multiple failed procedures. It is technically demanding, with many surgeons preferring to perform the uretero-ileal anastomosis as an extra-corporeal procedure. We present a technique of total intracorporeal uretero-ileal anastomosis.

Bladder neck closure and suprapubic catheter placement as definitive management of neurogenic bladder

ObjectiveSurgical management for neurogenic bladder may require abandonment of the native urethra due to intractable urinary incontinence, irreparable urethral erosion, severe scarring from previous transurethral procedures, or urethrocutaneous fistula. In these patients, bladder neck closure (BNC) excludes the native urethra and provides continence while preserving the antireflux mechanism of the native ureters. This procedure is commonly combined with ileovesicostomy or continent catheterizable stoma, with or without augmentation enterocystoplasty. Alternatively, BNC can be paired with suprapubic catheter diversion. This strategy does not require a bowel segment, resulting in shorter operative times and less opportunity for bowel-related morbidity. The study purpose is to examine preoperative characteristics, indications, complications, and long-term maintenance of renal function of BNC patients.MethodsA retrospective review of medical records of 35 patients who underwent BNC with suprapubic catheter placement from 1998 to 2007 by a single surgeon (LKL) was completed.ResultsNeurogenic bladder was attributable to spinal cord injury in 71%, 23% had multiple sclerosis, and 9% had cerebrovascular accident. Indications for BNC included severe urethral erosion in 80%, decubitus ulcer exacerbated by urinary incontinence in 34%, urethrocutaneous fistula in 11%, and other indications in 9%. The overall complication rate was 17%. All but two patients were continent at follow-up. Forty-nine per cent of patients had imaging available for review, none of which showed deterioration of the upper tracts.ConclusionsOur results suggest that BNC in conjunction with suprapubic catheter diversion provides an excellent chance at urethral continence with a reasonable complication rate.

1224 MANAGEMENT OF INTRACTABLE BLADDER NECK CONTRACTURE AND URINARY INCONTINENCE: LONG TERM EVALUATION

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101224 MANAGEMENT OF INTRACTABLE BLADDER NECK CONTRACTURE AND URINARY INCONTINENCE: LONG TERM EVALUATION Polina Reyblat, Priyanka Kadam, David A. Ginsberg, and Stuart D. Boyd Polina ReyblatPolina Reyblat More articles by this author , Priyanka KadamPriyanka Kadam More articles by this author , David A. GinsbergDavid A. Ginsberg More articles by this author , and Stuart D. BoydStuart D. Boyd More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence combined with intractable posterior urethra/ bladder neck contractures after radical prostatectomy or following radiation therapy for prostate cancer presents a very difficult management problem. Urinary incontinence is routinely managed with Artificial Urinary Sphincter (AUS), however, instrumentation required to perform multiple incisions, resections and/or dilations for treatment of recurrent bladder neck contracture is a contraindication for AUS placement. Placement of an Urolume stent across the posterior urethra/ bladder neck allows it to stay open while AUS provides continence. METHODS We retrospectively evaluated medical records of 16 men who underwent Urolume stent placement with subsequent implantation of the AUS between 2004 and 2009 (follow up ranging 5 to 61 months, mean 20.4 mo) RESULTS 16 men with a mean age of 76 (range 67-88) underwent combined Urolume stent placement with AUS implantation. Etiology of bladder neck contracture and incontinence was radiation therapy alone for prostate cancer in 6, radical prostatectomy alone in 5, radical prostatectomy with radiation therapy in 3, proton beam therapy in one, and radical cystoprostatectomy with orthotopic neobladder in one. Time from initial treatment to AUS/Urolume ranged from 5 months to 27 years. Number of prior incisions/dilations ranged from 3 to 18. Two patients required subsequent addition of a second Urolume stent for further stricture management. Out of 16 patients, 9 (56%) are completely dry, 6 (37%) report minimal leak upon exertion and use 1 pad a day. The AUS mechanism is turned off in one patient secondary to the development of dementia. Four patients require periodic CIC to maintain patency of the stent. Three patients required AUS revision. Four patients developed tissue growth into the Urolume stent requiring transurethral intervention. Of the 16 patients, 14 (88%) are satisfied with the results. These patients are older, more debilitated, or have longer strictures (>2.5cm) than patients receiving urethral reconstruction. CONCLUSIONS Combination of Urolume stent and artificial urinary sphincter can be effective in management of complicated bladder neck contractures with urinary incontinence in patients suffering consequences of prostate cancer treatment. This can be accomplished with minimal morbidity and significantly less invasiveness than the alternative of urinary diversion. Los Angeles, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e474 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Polina Reyblat More articles by this author Priyanka Kadam More articles by this author David A. Ginsberg More articles by this author Stuart D. Boyd More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-Term Results of Bulking Agent Injection for Persistent Incontinence in Cases of Neurogenic Bladder Dysfunction

We evaluated the effectiveness of bladder neck injection as a supplementary treatment for persistent low pressure incontinence after unsatisfactory fascial sling procedures in patients with neurogenic lower urinary tract dysfunction. A total of 89 patients with neurogenic lower urinary tract dysfunction underwent fascial sling procedures between 1992 and 2005. Because of unsatisfactory results, 27 patients received endoscopic injection of a bulking agent. All patients included in the study underwent urodynamic examination after the sling procedure, which revealed persistent low pressure transurethral leakage of urine. We retrospectively analyzed the endoscopic approach used to administer the bladder neck injection, method of postoperative catheterization and number of injections given. Efficacy of bladder neck injection was graded by the patient and the urologist. After a median followup of 8 years (range 2.5 to 14) only 2 patients (7%) were continent after having received a single injection of bulking agent. A total of 12 patients (44%) were given a second injection and 8 (30%) were given a third injection but these subsequent injections did not result in continence. Of the patients 16 (59%) eventually underwent bladder neck surgery, 2 (7%) were dry and 8 (30%) accepted the inconvenience. Two patients underwent ileocystoplasty and 1 patient underwent botulinum A toxin (Botox(R)) injection due to decreased bladder capacity and poor bladder compliance. Neither the endoscopic approach nor the method of postoperative catheterization affected the success rate. Bladder neck injection after failure of primary sling procedures has limited value in patients with neurogenic lower urinary tract dysfunction. Repeat bladder neck injection yields no additional benefits.

Bladder Neck Transection for Intractable Pediatric Urinary Incontinence

Bladder Neck Transection for Intractable Pediatric Urinary Incontinence

Complications of Complex Lower Urinary Tract Reconstruction in Patients With Neurogenic Versus Nonneurogenic Bladder—Is There a Difference?

The complications of lower urinary tract reconstruction have been well documented in children with neurogenic bladders. While most series include small numbers of nonneurogenic diagnoses, this group is typically underrepresented. Despite a number of fundamental anatomical and functional differences, a direct comparison of surgical complications of lower urinary tract reconstruction in patients with neurogenic vs nonneurogenic bladders has not been performed. We identified patients undergoing lower urinary tract reconstruction incorporating enterocystoplasty from 1996 to 2006. We performed a retrospective review of operative notes and medical records of patients who met inclusion criteria. Patients were divided into a neurogenic group and a nonneurogenic group based on the underlying diagnosis. The 2 groups were compared with respect to demographics, historical data, operative techniques, perioperative morbidity, long-term complications and need for surgical revision. Of the 127 patients who met inclusion criteria 72 were assigned to the nonneurogenic group and 55 to the neurogenic group. Overall the rates of significant perioperative morbidity (39%), long-term complications (54%) and need for surgical revision (39%) were substantial. The rates of catheter related complications, rehospitalization for dehydration and spontaneous bladder rupture were higher in the neurogenic group (p <0.05). Reconstruction of the lower urinary tract in children is associated with a considerable rate of complications and need for surgical revision regardless of whether the bladder is neurogenic or nonneurogenic. Children with neurogenic bladders are more prone to spontaneous rupture, catheter mishaps and early rehospitalization for dehydration.

Incidence and Risk Factors of Stomal Complications in Patients Undergoing Cystectomy With Ileal Conduit Urinary Diversion for Bladder Cancer

In this study we examined the incidence and associated factors of stomal complications in patients undergoing radical cystectomy with ileal conduit urinary diversion for bladder cancer. In addition, we evaluated the treatment and outcomes of surgical procedures in patients in whom stoma related complications developed. From 2001 to 2005 a total of 137 patients underwent ileal conduit diversion after cystectomy or exploration for bladder cancer, had complete clinical followup and were followed for at least 12 months after surgery. The incidence of stomal complications (including parastomal hernia, stomal stenosis and stomal prolapse) is reported with correlations made to age, race, gender, body mass index, smoking history, alcohol consumption, preoperative laboratory values (creatinine, hematocrit), operative estimated blood loss and surgical complications. In addition, management of stomal complications is reported. Of the 137 patients 21 stomal complications (15.3%) occurred in 20 patients (14.6%). The most common complication was parastomal hernia in 19 patients (13.9 %). Stomal stenosis developed in 1 patient (0.7%) and stomal prolapse developed in 1 patient with a parastomal hernia (0.7%). There were no significant differences in gender, age, race, preoperative laboratory values or history of abdominal/pelvic radiation therapy between patients with or without complications. However, patients in whom complications developed had a significantly higher mean body mass index compared to those without complications (30.8 vs 26.5 kg/m(2), respectively, p = 0.012). Operative outcomes, extent of disease and length of postoperative followup were also similar between patients with or without stomal complications. In addition, there were no significant differences in lifestyle factors (eg smoking, alcohol abuse) in patients in whom complications developed. Stomal complications associated with ileal conduit urinary diversion are not uncommon and occur in almost 15% of patients, with the most common problem being parastomal hernia. Evaluation of possible risk factors demonstrates that obesity may be a contributing factor in the development of stomal complications, particularly in the elderly. Furthermore, our experience suggests that subsequent repairs of parastomal hernias are only moderately successful.

Intentional urethral closure with a TVT (tension-free vaginal tape) for intractable urinary incontinence: a preliminary report of three cases

Bladder neck and urethral closure with urinary diversion is offered as a last resort to patients with intractable urinary incontinence. Various techniques have been described to achieve bladder neck and urethral closure. Most of these are associated with either operative morbidity or long-term complications. A modification of the conventional tension-free vaginal tape (TVT) procedure is described. As the name suggests, during the conventional TVT procedure, the tape is inserted relatively without tension in such a manner that the urethra retains its function and post-operative voiding is possible. In the cases described in this short series, the aim was to achieve urethral and bladder neck closure with minimal operative morbidity. This was achieved by inserting the TVT exactly as in a conventional TVT procedure, but the tape was inserted under greater tension than is normally used to ensure continence. A long-term suprapubic catheter was used for urinary diversion. This procedure is simple to perform, is associated with low operative morbidity [Agostini et al., Eur J Obstet Gynecol Reprod Biol, 124(2):237-239, 2006] and results in functional urethral closure. Results suggest that it may be a useful alternative to other bladder neck and urethral closure procedures in selected patients.

The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal

The term intractable urinary incontinence can be applied to urinary incontinence that cannot be managed using conventional treatments like drug therapy for detrusor overactivity or sling procedures for female stress incontinence. This review considers the role of the Mitrofanoff procedure in extending the range of options for the patient who might otherwise consider using an indwelling catheter or an ileal conduit diversion to overcome incontinence. Clinicians use the label 'Mitrofanoff procedure' quite loosely to describe any continent catheterizable abdominal stoma. For the purposes of this review, we will use the term in this generic sense while acknowledging our imprecision. Reviews confirm that the Mitrofanoff procedure has stood the test of time. Quality-of-life benefits, however, need a conclusive demonstration in scientific terms. Enthusiasts of laparoscopic surgery show that this type of lower urinary tract reconstruction can be carried out using minimally invasive methods. Reconstructive options using a catheterizable abdominal stoma should be discussed with patients with intractable urinary incontinence. Reliable surgical techniques are established; though complications are frequent, most can be dealt without recourse to major surgical intervention. Unfortunately, authoritative data on the impact of the Mitrofanoff procedure on patients' qualities of life are still lacking.

Outcomes of bladder neck closure for intractable urinary incontinence in patients with neurogenic bladders

Objective Recent reports of outcomes of bladder neck closure for neurogenic urinary incontinence reveal poor initial continence and high vesicourethral fistula rates. We evaluated a large series of patients who underwent complete transection and closure of the bladder neck with modified abdominal stoma creation. Materials and methods The medical records of 52 consecutive patients (23 males and 29 females) undergoing bladder neck closure by a single surgeon between July 1996 and January 2003 were reviewed. Mean follow up was 20 months (range 2–68 months) and mean age was 13.9 years (range 1.5–58 years). Forty-two patients (81%) underwent concomitant bladder augmentation. Catheterizable stomas included 46 appendicovesicostomies (88%) and six Monti tubes (12%). Of the 52 patients, 22 were confined to wheelchairs (42%), and the majority of patients had spinal cord pathology (40/52, 77%). Mean preoperative vesical leak point pressure was 25 cm/H 2O (range 4–69 cm/H 2O). Results Complete postoperative urinary continence was achieved in 44 patients (88%) after one procedure. Of the six patients who were incontinent (12%), one had a vesicourethral fistula (2%) and five had incontinence at the urinary diversion stoma (10%). Twelve of 50 patients had urinary stomal stenosis (24%), with six requiring urgent evaluation (12%) and six requiring surgical revision (12%). Postoperative urinary continence was unknown in two patients due to inadequate follow-up data. Conclusions Our findings suggest that bladder neck closure is a safe and effective method of achieving urinary continence in children with neurogenic voiding dysfunction. While there are risks of stomal stenosis and fistula formation, modifications in surgical technique may reduce them to acceptable levels.

Long-term results of suprapubic bladder neck closure for treatment of the devastated outlet

Objectives To assess the long-term success of suprapubic bladder neck closure in patients with irreparably damaged bladder outlets. Methods A cohort of 35 patients with intractable urinary incontinence secondary to severe posterior urethral/bladder neck damage underwent suprapubic bladder neck closure. Patients were assessed with regard to the success of procedure, as well as early and late complications. Results With a mean follow-up of 79 months (range 12 to 164), suprapubic bladder neck closure was successful in 29 (83%) of 35 patients. One revision of the bladder neck improved the success rate to 94% (33 of 35). Early and late complications, excluding bladder neck fistula, were reported in 3 (9%) and 5 (14%) of 35 patients, respectively. Conclusions High success and acceptable complication rates can be achieved with suprapubic bladder neck closure for the treatment of severe urinary incontinence secondary to a devastated bladder outlet.

STOMAL COMPLICATIONS OF ILEAL CONDUITS ARE SIGNIFICANTLY HIGHER WHEN FORMED IN WOMEN WITH INTRACTABLE URINARY INCONTINENCE

The ileal conduit is held to be the safest and simplest form of urinary diversion. There are few reports about long-term problems after ileal conduit formation, especially intractable urinary incontinence in females. We reviewed long-term stomal complications in patients with an ileal conduit. Notes on 93 consecutive patients in whom an ileal conduit was created were reviewed. Information was collected on patient demographics, indications for an ileal conduit and long-term complications, in particular parastomal and incisional hernias, stomal retraction, stenosis or prolapse and the development of a redundant loop. Mean followup available was 63.4 months (range 1 to 434). A total of 33 males with a mean age of 60.1 years (range 2 to 78) and 60 females with a mean age of 48.2 years (range 4 to 79) underwent ileal conduit diversion. The main indications for an ileal conduit were intractable incontinence in 44 patients (47%), cancer in 31 (33%) and interstitial cystitis in 8 (9%). In male, continent female and incontinent female patients A parastomal hernia developed in 3 (9%), 2 (9.5%) and 12 (31%), an incisional hernia developed in 1 (3%), 1 (4.8%) and 2 (5%), stomal retraction developed in 0, 2 (9.5%) and 12 (31%), stomal stenosis developed in 0 (0%), 1 (4.8%) and 6 (15.4%), and a redundant loop developed in 0 (0%), 2 (9.5%) and 5 (12.8%), respectively. A total of 23 patients (24.7%) required further surgery for stomal problems with 13 (57%) requiring more than 1 reoperation, of whom 9 were incontinent females. An ileal conduit is associated with a stomal complication rate of 34.4% (61% in incontinent females and 18% in other patients) and a 4.3% incisional hernia rate. Reoperation is required for stomal complications in 24.7% of cases. Stomal complication rates and reoperation rates vary by sex and the indication for ileal conduit, and they are significantly higher for those performed for intractable urinary incontinence in females.