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Lepoittevin L, Leon G, Perrouin-Verbe B, Lefort M, Reiss B, Karam G, Rigaud J, Le Normand L, Perrouin-Verbe MA. [External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results]. Prog Urol 2021; 32:40-46. [PMID: 33541792 DOI: 10.1016/j.purol.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). METHODS Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary outcomes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. RESULTS The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n=41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P<0.001), urinary tract infections (UTI) (31 vs 15 patients, P<0.001) and a significant decrease in post-voiding residuals (200 vs 50mL, P<0.001). CONCLUSION ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is mandatory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Lepoittevin
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France.
| | - G Leon
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - B Perrouin-Verbe
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - M Lefort
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - B Reiss
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - G Karam
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - J Rigaud
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - L Le Normand
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - M A Perrouin-Verbe
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Deboudt C, Perrouin-Verbe MA, Le Normand L, Perrouin-Verbe B, Buge F, Rigaud J. Comparison of the morbidity and mortality of cystectomy and ileal conduit urinary diversion for neurogenic lower urinary tract dysfunction according to the approach: Laparotomy, laparoscopy or robotic. Int J Urol 2016; 23:848-853. [DOI: 10.1111/iju.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Loic Le Normand
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation; University Hospital of Nantes; Nantes France
| | - François Buge
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Jérôme Rigaud
- Department of Urology; University Hospital of Nantes; Nantes France
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Delaume A, Védrine N, Guandalino M, Mulliez A, Bruyère F, Boiteux JP, Guy L. Comparaison des anastomoses Bricker et Wallace dans les urétérostomies cutanées trans-iléales : étude rétrospective, multicentrique. Prog Urol 2016; 26:58-64. [DOI: 10.1016/j.purol.2015.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/15/2015] [Accepted: 09/04/2015] [Indexed: 11/28/2022]
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Caremel R, Phé V, Bart S, Castel-Lacanal E, De Sèze M, Duchene F, Bertrandy-Loubat M, Mazerolles M, Scheiber-Nogueira MC, Karsenty G, Gamé X. [Expert opinion on surgical care pathway management of neurologic patients from Neuro-Urology Committee of the French National Association of Urology (AFU)]. Prog Urol 2012; 23:309-16. [PMID: 23545005 DOI: 10.1016/j.purol.2012.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/06/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
The surgical care pathway of neurologic patients has two aims: preventing urinary morbidity and mortality and improving their quality of life. It requires taking into account the specificities of disabilities in domains of body functions: circulatory, ventilation and digestive physiology, motor functions, sensory functions, mental functions, and skin fragility which are responsible of dependencies in this heterogeneous group of patients. This management is necessarily multidisciplinary to be optimal and through specific clinical care pathway, providing guidance to the surgical procedure: preparation of the surgery, its realization, and post-operative rehabilitation. The indication for surgery must be coordinated and validated in neuro-urology multidisciplinary staff. Preoperative stay in a physical and rehabilitation medicine center may be useful to ensure a complete assessment and anticipate problems related to surgery. The patient will be hospitalized in the urology department in a single room suited to their disabilities and handicaps. The chronic treatments should be not modified if possible. The lack of sensitivity does not dispense anesthesia to prevent autonomic hyperreflexia, the most severe complication after high complete spinal cord injury. The laparoscopy and sub-peritoneal surgery, the early removal nasogastric tube and early refeeding make it possible to early resumption of intestinal transit. In many cases, the patients should be transferred to a physical and rehabilitation medicine during post-operative period where the nursing care will be most suitable. A quickly adapted rehabilitation must be able to reduce loss of function and physical dependence.
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Affiliation(s)
- R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Guillotreau J, Castel-Lacanal E, Roumiguié M, Bordier B, Doumerc N, De Boissezon X, Malavaud B, Marque P, Rischmann P, Gamé X. Prospective study of the impact on quality of life of cystectomy with ileal conduit urinary diversion for neurogenic bladder dysfunction. Neurourol Urodyn 2011; 30:1503-6. [DOI: 10.1002/nau.21121] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/07/2011] [Indexed: 01/09/2023]
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Étude prospective de l’impact sur la qualité de vie de la réalisation d’une dérivation urinaire cutanée transiléale non continente pour troubles vésicosphinctériens d’origine neurologique. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s11608-010-0334-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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