Continent catheterizable vesicostomy in an adult population: success at high costs
| Autor: | Frank Van der Aa, Karen De Baets, Steven Joniau, Dirk De Ridder |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Counseling Reoperation medicine.medical_specialty Time Factors Urology medicine.medical_treatment Urinary Bladder Appendix Risk Assessment Stoma Young Adult Patient satisfaction Ileum Risk Factors Medicine Humans Aged Retrospective Studies Aged 80 and over business.industry Patient Selection Urinary diversion Urinary Bladder Diseases Middle Aged Surgery Cystostomy Neck of urinary bladder Urodynamics Logistic Models Treatment Outcome Bladder augmentation Patient Satisfaction Mitrofanoff principle Neurology (clinical) business Complication Urinary Catheterization Continent Urinary Diversion |
| Zdroj: | Neurourology and urodynamics. 28(6) |
| ISSN: | 1520-6777 |
| Popis: | Aims To evaluate the long term outcome, to review the complication ratio and to analyze predicting factors of catheterizable continent vesicostomy in an adult population. To deduct a proper patient counseling policy. Methods We identified all patients that underwent a continent vesicostomy between 1998 and 2008. We did not consider patients that underwent orthotopic bladder reconstruction. Patient satisfaction, urinary leakage, catheterization problems were assessed by chart review or interview. Type of primary surgery, revisions (number and type), renal function and complications were assessed by chart review. Results Thirty-four patients underwent continent vesicostomy using an ileal segment (Monti or Spiral-Monti/Casale technique) or the appendix (Mitrofanoff). One patient underwent a detrusor wall flap. Twenty-one out of 35 patients underwent concomitant bladder augmentation and 2/35 patients bladder neck closure. Mean age at the time of the procedure was 44 years (range 21–80 years). Mean follow up is 60 months (range 6–117 months). Six out of 35 patients undergo surgical excision of the conduit because of untreatable problems. One patient has a permanent indwelling catheter. Two patients voided normal after sacral nerve stimulation. Ten out of 35 patients undergo stoma related revisions. Sixteen out of 35 patients undergo no stoma related revisions. Finally 26/35 patients were continent and had an easy catheterizable stoma. Conclusions Continent urinary diversion in an adult population is associated with a high complication and revision rate. Although conversion rate to an ileal conduit is appreciable, the majority of patients (26/35) finally achieve full continence and unobstructed access to the bladder. Neurourol. Urodyn. 28:487–491, 2009. © 2009 Wiley-Liss, Inc. |
| Databáze: | OpenAIRE |
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