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Supratrigonal cystectomy with hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: Long‐term functional results
Author(s) -
Gobeaux Nicolas,
Yates David R.,
Denys Pierre,
EvenSchneider Alexia,
Richard Francois,
ChartierKastler Emmanuel
Publication year - 2012
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.21239
Subject(s) - medicine , spinal cord injury , cystectomy , spinal cord , surgery , bladder cancer , cancer , psychiatry
Abstract Aims To study clinical and urodynamic data along with immediate and long‐term morbidity of surgical management of neurogenic bladder in spinal cord injury (SCI) patients Methods Single‐center retrospective study of 61 SCI patients with neurogenic detrusor overactivity (NDO) related urinary incontinence and/or sphincter weakness incontinence who underwent supratrigonal cystectomy with Hautmann pouch ± concomitant stress incontinence procedure (27.9%; n = 17). Results With a mean follow‐up of 5.84 years (range 1–20.5) an improved or total continence rate was achieved in 89.7% and 74.1%, respectively. Surgery failed (incontinence persisted) for six (10.3%) patients, three of which had a simultaneous procedure for stress incontinence. On urodynamics, maximum cystometric capacity (MCC) (ml) increased from 305.2 to 509.4 ( P < 0.05), mean compliance (ml/cmH 2 O) increased from 15 to 42.7 ( P < 0.05) and mean detrusor pressure at MCC (cmH 2 O) fell from 54.1 to 19.1 ( P < 0.05). Persisent NDO occurred in 20.7% compared to 59% pre‐operatively ( P < 0.05). The overall complication rate was 37.7% but ≤Clavien grade 2 in 82.6%. Notably, the incidence of bowel dysfunction, namely diarrhea and/or fecal incontinence was 27.5%. Concomitant outlet surgery was associated with increased morbidity as three (17.6%) complications led to re‐intervention. Conclusions Supratrigonal cystectomy with Hautmann pouch is an excellent surgical treatment for SCI patients suffering from refractory NDO incontinence. It achieves the main goals of achieving continence (74% complete), reducing rates of infection and preserving upper tract function, which is reflected in the improvement on urodynamics. The incidence of secondary bowel dysfunction and potential risk of a simultaneous procedure for stress incontinence needs to be discussed. Neurourol. Urodynam. 31:672–676, 2012. © 2012 Wiley Periodicals, Inc.