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Long‐term complications of continent cutaneous urinary diversion in adult spinal cord injured patients
Author(s) -
PerrouinVerbe MarieAimée,
ChartierKastler Emmanuel,
Even Alexia,
Denys Pierre,
Rouprêt Morgan,
Phé Véronique
Publication year - 2016
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.22879
Subject(s) - medicine , surgery , spinal cord injury , urinary diversion , concomitant , urethra , urinary continence , stenosis , bladder augmentation , urinary incontinence , neck of urinary bladder , cystostomy , urinary system , stoma (medicine) , urology , urinary bladder , spinal cord , cystectomy , bladder cancer , prostate , cancer , psychiatry , prostatectomy
Objective To report the long‐term complications of continent cutaneous urinary diversion(CCUD) in spinal cord injured(SCI) patients unable to perform intermittent self‐catheterization(ISC) through the urethra. Materials and Methods Between July 2001 and January 2012, adult SCI patients with a neurogenic bladder who underwent CCUD according to Mitrofanoff's/Monti's/Casale's principle were enrolled. A concomitant supratrigonal and augmentation enterocystoplasty were performed because of refractory detrusor overactivity or low bladder compliance. Early postoperative complications were reported according to Clavien‐Dindo classification. Long‐term complications, stomal and urethral continence, renal function, urodynamic parameters and quality‐of‐life were assessed. Results Overall, 29 consecutive SCI patients were included, median age 35 years (IQR 26–46). Median follow‐up time was 66 months (IQR 50–80). Two post‐operative severe complications (grade III–IV) were reported. One patient had a stomal stenosis and another patient a tube stenosis. Both were treated by dilation. Two patients developed fistulae between the tube and the skin and required a surgical treatment. Three patients had bladder stones managed with endoscopy. Two patients had remnant stress urine leakage through the urethra, which was treated surgically: one received periurethral balloons(ACT TM ) and one a tension‐free vaginal tape. Creatinine clearance remained stable postoperatively. Urodynamic parameters were significantly improved. At last follow‐up, 100% of patients had a catheterizable continent stoma and urethral continence was achieved in 96%. An improvement of quality‐of‐life was reported by 90% of patients. Conclusions CCUD allowed these patients to keep ISC as a voiding pattern and to be continent without any appliance. The main complications were related to the tube and to bladder enlargement; thus, annual monitoring is required. Neurourol. Urodynam. 35:1046–1050, 2016 . © 2015 Wiley Periodicals, Inc.