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Incontinent ileovesicostomy in the management of neurogenic bladder dysfunction
Author(s) -
Gauthier Anthony R.,
Winters J. Christian
Publication year - 2003
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.10093
Subject(s) - medicine , surgery , foley catheter , bladder augmentation , neck of urinary bladder , anastomosis , ileus , catheter , urinary bladder
Aims To report outcome and urodynamic follow‐up of incontinent ileovesicostomy in quadriplegic patients with neurogenic bladder. Methods Seven patients (five male, two female; mean age, 33.7 yr) with neurogenic bladder underwent ileovesicostomy for management of leakage or complications of chronic catheter drainage. Five had chronic indwelling catheters: three suprapubic and two urethral. Preoperatively, all had upper tract evaluation and videourodynamics. All seven patients had detrusor hyperreflexia. Preoperative detrusor leak point pressures averaged 42.7 cm H 2 O. Two females had intrinsic sphincteric deficiency from prolonged Foley catheter drainage. Ileovesicostomy involves isolation of a 15—20‐cm segment of terminal ileum. The proximal 6–8 cm of this segment is opened on the antimesenteric border. The dome of the bladder is opened widely in a transverse manner and the proximal portion of the bowel is sutured onto the bladder. The distal portion of the ileum remains tubularized and becomes the stoma. Results There were no intraoperative complications. Operative time averaged 159 minutes. Associated procedures included removal of bladder calculus (n = 1), pubovaginal sling (n = 2), and Marshall Marchetti Krantz suspension (n = 1). Mean blood loss was <200 cc in six patients. Mean hospital stay was 8 days. Complications in two patients included: fascial stenosis requiring stoma revision (n = 1), wound infection (n = 1), and postoperative ileus (n = 1). Mean follow‐up was 37.4 months. Postoperatively, mean detrusor leak point pressures were 16.7 cm H 2 O ( P = 0.0061). Patient satisfaction is high with only one complaint of occasional difficulty fitting the appliance. Conclusions Ileovesicostomy is an effective method of urinary drainage in quadriplegic patients. Detrusor leak point pressures were lowered, and upper tracts were preserved. No long‐term complications were encountered. Neurourol. Urodynam. 22:142–146, 2003. © 2003 Wiley‐Liss, Inc.