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Complications of non-continent cutaneous urinary diversion in adults with spinal cord injury: a retrospective study

Spinal Cord (2018) | Download Citation

Abstract

Study design

Retrospective cohort study.

Objectives

To report the long-term complications of non-continent cutaneous urinary diversion (NCCUD) in adult patients with spinal cord injury (SCI).

Setting

Hospital in Paris, France.

Methods

A retrospective single center study included all adult patients with SCI who underwent an ileal conduit between 1997 and 2014. Early complications were reported according to Clavien-Dindo classification. Long-term complications and reoperation rates were recorded, as well as stoma management and autonomy improvement related to urinary function.

Results

One hundred and two patients were included. The surgical indications included failure of intermittent catheterization (n = 43), urethral fistulae due to skin ulcers (n = 50), renal failure (n = 8), recurrent urinary tract infections (n = 9), lithiasis (n = 3), and bladder tumors (n = 2). There were 67 early postoperative complications for 44 patients (43%) leading to an additional surgery in 15 cases: 30 grade I–II, 30 grade III, 6 grade IV, and 1 grade V. A total of 37 late complications were reported for 36 patients (35%): 17 ureteral anastomosis stenosis, 3 stoma hernia, 3 pyocystis (3/15 patients), 7 pyelonephritis, 2 renal failures, 2 ureteral lithiasis, 1 uterine prolapse, 1 incisional hernia, and 1 tumor recurrence. Renal function remained unchanged (p = 0.53). Autonomy related to urinary function was improved in 88% of patients. The correct fitting of the stoma was possible for 81% of the patients.

Conclusions

Despite a perioperative morbidity rate of 43% and a late complication rate of 35%, as a last resort procedure, NCCUD is an end-stage solution in patients with SCI to preserve renal function and achieve autonomy.

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Acknowledgements

We thank Eleonora Spanudakis for her review of the manuscript.

Author information

Affiliations

  1. Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France

    • Cyrille Guillot-Tantay
    • , Emmanuel Chartier-Kastler
    • , Marie-Aimée Perrouin-Verbe
    • , Priscilla Léon
    •  & Véronique Phé
  2. Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Garches, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France

    • Pierre Denys

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Cyrille Guillot-Tantay.

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DOI

https://doi.org/10.1038/s41393-018-0083-1