A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra.

摘要

Study design:Description of a technique and prospective follow-up study.Objectives:To present and assess a perioperative strategy associated with a single-procedure surgical technique for continent cutaneous diversion in spinal cord injury (SCI) patients requiring self-catheterization and unable to do it through the native urethra.Setting:University hospital, Paris, France.Methods:We considered SCI patients suffering from urinary incontinence related to neurogenic detrusor overactivity and/or poor bladder emptying for more than 1 year and inability to perform self-catheterization through the native urethra. These patients including quadriplegics underwent selection for surgery by occupational therapists and neurorehabs to assess the ability to self catheterize through an abdominal stoma and to determine the optimal site to place the stoma. The surgical technique included a single procedure: aponevrotic sling in women requiring stress continence reinforcement, supratrigonal cystectomy, preserved detrusor wall flap (original description), enterocystoplasty, a catheterizable tube using either the Mitrofanoff or Young-Monti principle and Politano-Leadbetter anti-reflux technique. A prospective follow-up study of consecutive patients reviewed initial condition, indication, surgical technique, complications, continence, catheterizing difficulties, functional bladder capacity and serum creatinine.Results:Thirteen consecutive patients were selected for surgery. Median follow-up was 44 months. Stoma location was variable from one patient to another. All patients had a catheterizable continent stoma at last follow-up. Kidney function was preserved.Conclusion:Given these results, a multidisciplinary approach including neuro-rehabilitation practitioners and urologists performing appropriate technical solutions in highly selected SCI patients unable to catheterize native urethra provides upper urinary tract protection and continence after a single procedure.Spinal Cord (2008) 46, 305-310; doi:10.1038/sj.sc.3102104; published online 14 August 2007.