A Modification to Augmentation Cystoplasty With Catheterizable Stoma for Neurogenic Patients: Technique and Long-term Results
| Autor: | Timothy B. Boone, Sophie G. Fletcher, Joceline Liu, Rose Khavari |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Urology medicine.medical_treatment Urinary system Urinary Bladder Urinary catheterization Artificial urinary sphincter Young Adult Stoma (medicine) Ileum medicine Humans Urinary Bladder Neurogenic Cecum Aged Retrospective Studies Urinary bladder business.industry Middle Aged medicine.disease Surgery Cystostomy Neck of urinary bladder Treatment Outcome medicine.anatomical_structure Seroma Female Bladder stones Urinary Catheterization business |
| Zdroj: | Urology. 80:460-465 |
| ISSN: | 0090-4295 |
| Popis: | Objective To evaluate the use of a modified Indiana continent urinary reservoir, the Indiana augmentation cystoplasty (IAC), for patients with neurogenic bladder (NGB). NGB with incontinence can be devastating for patients with neurologic illness. Augmentation cystoplasty with a continent catheterizable stoma creates a continent, low-pressure storage system, with catheterizable cutaneous stoma, leading to decreased urinary tract morbidity and increased quality of life. Methods Retrospective chart review of the IAC procedure in a single center from 1993 to 2010 was performed and included subjects with NGB and minimum 1-year follow up. Patients' demographics, NGB diagnosis, surgery details, urodynamic findings, concurrent operations, complications, and continence outcomes were recorded. Results Thirty-four patients met the inclusion criteria. Mean age at time of surgery was 39.8 years. Neurologic diagnoses included multiple sclerosis (n = 12), spina bifida (n = 9), and spinal cord injury (n = 14). Concurrent surgeries included: bladder neck closure (n = 3), pubovaginal sling (n = 4), hysterectomy (n = 3), artificial urinary sphincter (n = 1), and cystolithotomy (n = 1). Mean estimated blood loss was 461.8 mL. Short-term postoperative complications were prolonged ileus (n = 2), wound infection (n = 1), and transfusion (n = 1). Median follow-up was 31 months. Long-term complications occurred in 15 (44.1%) patients: recurrent urinary tract infections (n = 4), pyelonephritis (n = 1), pelvic abscess (n = 1), seroma (n = 1), bladder stones (n = 2), and stomal revision in (n = 4). All patients were continent at latest follow-up. Conclusion This modification of the Indiana continent urinary reservoir is an excellent surgical option providing a low-pressure reservoir with a reliable continence mechanism and easily catheterizable stoma, with few complications or need for reoperation. |
| Databáze: | OpenAIRE |
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