[Continent cystostomies - indications, surgical technique, complications and management]

Isolated continent cystostomy on neurologic native bladder: Functional results

INTRODUCTION

Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement.

METHODS

Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported.

RESULTS

Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7).

DISCUSSION

The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined.

LEVEL OF EVIDENCE

Grade C - retrospective study.

[Isolated continent urinary diversion: An interesting or often regretted indication?]

INTRODUCTION

The aim of this study is to evaluate the percentage of patients developing vesical overactivity after the realization of a continent stoma without bladder enlargement.

MATERIAL AND METHOD

This is a retrospective monocentric study between January 2007 and April 2021. Patients undergoing an isolated continent urinary diversion for neurological or non-neurological reasons were included. The data collected concerned the clinical symptoms of bladder overactivity and their treatment as well as the pre- and postoperative urodynamic information.

RESULTS

During the period, 9 patients were included. The main indications for continent urinary diversion were patients with spinal cord injury. Clinical bladder overactivity was found postoperatively in 78% (7) of the patients, and detrusor overactivity in 57% (4) of them. The main symptoms were urinary incontinence (67%) and pollakiuria (56%, 5 patients). Most of the patients benefited from associated treatments (78% pre- and postoperative), mainly anticholinergic drugs. No patient required botulinum toxin injections preoperatively, compared with 6 (67%) postoperatively. The time of initiation of these injections varied between 3 and 8 months postoperatively.

CONCLUSION

Isolated continent urinary diversion seems to induce or increase bladder overactivity. A larger multicentric study is necessary to validate our hypothesis.

LEVEL OF EVIDENCE: 4