Document Detail


Supratrigonal cystectomy with hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: Long-term functional results.
MedLine Citation:
PMID:  22532256     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIMS: To study clinical and urodynamic data along with immediate and long-term morbidity of surgical management of neurogenic bladder in spinal cord injury (SCI) patients METHODS: Single-center retrospective study of 61 SCI patients with neurogenic detrusor overactivity (NDO) related urinary incontinence and/or sphincter weakness incontinence who underwent supratrigonal cystectomy with Hautmann pouch ± concomitant stress incontinence procedure (27.9%; n = 17). RESULTS: With a mean follow-up of 5.84 years (range 1-20.5) an improved or total continence rate was achieved in 89.7% and 74.1%, respectively. Surgery failed (incontinence persisted) for six (10.3%) patients, three of which had a simultaneous procedure for stress incontinence. On urodynamics, maximum cystometric capacity (MCC) (ml) increased from 305.2 to 509.4 (P < 0.05), mean compliance (ml/cmH(2) O) increased from 15 to 42.7 (P < 0.05) and mean detrusor pressure at MCC (cmH(2) O) fell from 54.1 to 19.1 (P < 0.05). Persisent NDO occurred in 20.7% compared to 59% pre-operatively (P < 0.05). The overall complication rate was 37.7% but ≤Clavien grade 2 in 82.6%. Notably, the incidence of bowel dysfunction, namely diarrhea and/or fecal incontinence was 27.5%. Concomitant outlet surgery was associated with increased morbidity as three (17.6%) complications led to re-intervention. CONCLUSIONS: Supratrigonal cystectomy with Hautmann pouch is an excellent surgical treatment for SCI patients suffering from refractory NDO incontinence. It achieves the main goals of achieving continence (74% complete), reducing rates of infection and preserving upper tract function, which is reflected in the improvement on urodynamics. The incidence of secondary bowel dysfunction and potential risk of a simultaneous procedure for stress incontinence needs to be discussed. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.
Authors:
Nicolas Gobeaux; David R Yates; Pierre Denys; Alexia Even-Schneider; Francois Richard; Emmanuel Chartier-Kastler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-24
Journal Detail:
Title:  Neurourology and urodynamics     Volume:  -     ISSN:  1520-6777     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8303326     Medline TA:  Neurourol Urodyn     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
Department of Urology, Groupe Hospitalier Pitié-Salpétrière, Paris, AP-HP, Medical School Pierre et Marie Curie, Paris VI University, Paris, France.
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