Abstract
The aim of this study was to investigate the efficacy and morbidity of cutaneous ileocystostomy, as an alternative to cystectomy and ileal conduit urinary diversion, for patients with end-stage neurogenic vesical dysfunction. Three male and eight female patients, mean age 41 years (range 28–59), with a mean duration of a neuropathic bladder of 8 years (range 4–17 years) underwent evaluation for ileocystostomy urinary diversion. Indications for the procedure included a bladder capacity ≤ 200 ml (10 patients), recurrent febrile urinary tract infection (nine patients), and urinary incontinence despite an indwelling urethral catheter (all eight women). Each was felt to be a poor candidate for, or refused, continent urinary diversion or bladder augmentation cystoplasty. All eight females required concomitant pubovaginal sling urethral compression to eliminate urinary leakage from a patulous, non-functional urethra. Two patients required bilateral ureteral reimplantation for grade III-IV/V reflux. Effective low-pressure urinary stomal drainage was achieved without the need for chronic catheterization in all of the patients with a mean duration of follow-up of 24 months (range 6–60 months). No patient has developed pyelonephritis since the procedure. Urethral urinary leakage was eliminated in all of the female patients, whilst vesicoureteral reflux resolved in those with reflux preoperatively.
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Thomas D G, Clarks S J . The urological status of 86 females following spinal cord injury. Br J Urol 1979; 51: 515–517.
Barkin M et al. The urologic care of the spinal cord injury. J Urol 1983; 129: 335–339.
Lapides J, Diokno A C, Silber S J, Lowe B S . Clean intermittent self-catheterization in the treatment of urinary tract disease. J Urol 1972; 107: 458–461.
Kuhn W, Rist M, Zaech G A . Intermittent urethral self-catheterization: long term results (bacteriological evolution, continence, acceptance, complications). Paraplegia 1991; 29: 222–232.
McMaster W C, Nicholas J J, Rosen J S . Intermittent catheterization for spinal-cord injury patients with chronic indwelling urethral catheters. Arch Phys Med Rehabil 1972; 53: 563–567.
Cordonnier J J . Ileocystostomy for neurogenic bladder. J Urol 1957; 78: 605–610.
Blaivas J G, Jacobs B Z . Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol 1991; 145: 1214–1218.
McGuire E J et al. Experience with pubovaginal slings for urinary incontinence at the University of Michigan. J Urol 1987; 138: 525–526.
Wan J L, McGuire E J . Augmentation cystoplasty and closure of the urethra for the destroyed lower urinary tract. J Am Paraplegia Soc 1990; 13: 5–40.
Timoney A G, Shaw P J . Urological outcome in female patients with spinal cord injury: the effectiveness of intermittent catheterization. Paraplegia 1990; 28: 556–5563.
McGuire E J, Savastano J A . Comparative urological outcome in women with spinal cord injury. J Urol 1986; 135: 730–731.
Stover S L, Lloyd K, Waites K B, Jackson A B . Urinary tract infection in spinal cord injury. Arch Phys Med Rehabil 1989; 70: 47–54.
Goble N M, Clarke T, Hammonds J C . Histological changes in the urinary bladder secondary to urethral catheterization. Br J Urol 1989; 63: 354–357.
Bejany D E, Lockhart J L, Rhamy R K . Malignant vesical tumors following spinal cord injury. J Urol 1987; 138: 1390–1392.
Bickel A, Culkin D J, Wheeler J S . Bladder cancer in spinal cord injury patients. J Urol 1991; 146: 1240–1242.
Broecker B H, Klein F A, Hackler R H . Cancer of the bladder in spinal cord injury patients. J Urol 1981; 125: 196–197.
Melzak J . The incidence of bladder cancer in paraplegia. Paraplegia 1967; 4: 85–89.
Locke J R, Hill D E, Walzer Y . Incidence of squamous cell carcinoma in patients with long-term catheter drainage. J Urol 1985; 133: 1034–1035.
Jackson A B, De Vivo M . Urological long-term follow-up in women with spinal cord injuries. Arch Phys Med Rehabil 1992; 73: 1029–1035.
Mundy A R, Nurse D E, Dick J A, Murray K H A . Complex urinary undiversion. Br J Urol 1986; 58: 640–643.
Reid R, Schneider K, Fruchtman . Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence. J Urol 1978; 120: 40–42.
Feneley R C L . The management of female incontinence by suprapubic catheterization, with or without urethral closure. Br J Urol 1983; 55: 203–207.
Griffiths I H . Anterior transposition of the urethra. Br J Urol 1960; 32: 27–31.
Zimmern P E, Hadley H R, Leach G E, Raz S . Transvaginal closure of the bladder neck and placement of a suprapubic catheter for destroyed urethra after long-term indwelling catheterization. J Urol 1985; 134: 554–557.
Blaivas J G, Olsson C A . Stress incontinence: classification and surgical approach. J Urol 1988; 139: 727–731.
Morgan J E, Farrow G A, Stewart R N . The Marlex sling operation for the treatment of recurrent stress urinary incontinence: a 16-year review. Am J Obstet Gynecol 1985; 151: 224–226.
Raz S et al. Fascial sling to correct male neurogenic sphincter incompetence: The McGuire/Raz approach. J Urol 1988; 139: 528–531.
Chancellor M B, Erhard M J, Kiilholma P J, Rivas D A . Functional urethral closure with pubovaginal sling for destroyed female urethra after long-term urethral catheterization. Urology 1994; 43: 499–505.
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Rivas, D., Karasick, S. & Chancellor, M. Cutaneous ileocystostomy (a bladder chimney) for the treatment of severe neurogenic vesical dysfunction. Spinal Cord 33, 530–535 (1995). https://doi.org/10.1038/sc.1995.114
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DOI: https://doi.org/10.1038/sc.1995.114
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