Management of neurogenic bladder dysfunction with incontinent ileovesicostomy.

摘要

OBJECTIVES: Incontinent ileovesicostomy is an alternative form of urinary management applied to patients with neurogenic vesical dysfunction who are either unable or unwilling to perform clean intermittent self-catheterization or assisted catheterization. We review our operative results, urodynamic data, and complications observed in patients who underwent creation of incontinent ileovesicostomy at our institution. METHODS: Thirteen patients (mean age 43.2 years) with neurogenic bladder dysfunction underwent an incontinent ileovesicostomy between 1994 and 1998. The etiologies of the neurogenic bladder dysfunction were spinal cord injury in 8 patients, multiple sclerosis in 4 patients, and tuberculous meningitis in 1 patient. The preoperative data, surgical records, urodynamic findings, and postoperative complications were assessed. RESULTS: All patients experienced complications of their pretreatment bladder management. The mean operating room time was 242 minutes (range 170 to 395), including 14 additional procedures in 1 1 patients. The mean estimated blood loss was 403.8 mL (range 50 to 2000). No patient required blood transfusion. There were no intraoperative complications. Only 1 patient required reoperation for stomal revision. One patient had a ureteral stone 2 years after surgery; 1 patient has continued to have urinary tract infections despite a negative workup. The mean follow-up was 23 months (range 6 to 57). The mean bladder leak point pressure through the stoma was 8.2 cm H2O. CONCLUSIONS: The incontinent ileovesicostomy is a useful technique in the treatment of patients with neurogenic bladder unable to perform clean intermittent catheterization. It provides patients with a low-pressure urinary conduit that empties readily without an in dwelling catheter.