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

Abstract

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 selfcatheterization 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 selfcatheterization 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 antireflux 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.

Long‐term complications of continent cutaneous urinary diversion in adult spinal cord injured patients

“…They must request this surgery after careful information. These patients must be evaluated by a multidisciplinary team including a urologist and a rehab physician to assess their ability to reach a fake abdominal stoma and to perform subsequent ISC . If necessary, some patients can undergo prior surgery for upper‐limb reanimation, especially tetraplegic patients (upper C8).…”

“…All the included patients had a persistent DO or low bladder compliance, requiring a concomitant supratrigonal cystectomy with augmentation enterocystoplasty. The supratrigonal cystectomy was performed with a preserved 3‐cm‐width postero‐lateral bladder‐wall flap in which the efferent tube could be implanted . The bladder dome was opened and excised up to 2 cm from its base.…”

Continent catheterizable tubes/stomas in adult neuro-urological patients: A systematic review

“…The PRISMA flow diagram of the literature search and results is shown in Supplementary Material S3. After the screening of 3,634 abstracts, a total of 11 studies were included in a narrative synthesis after title, abstract and full text screening …”

Self-catheterization acquisition after hand reanimation protocols in C5–C7 tetraplegic patients

“…18 ULR procedures were systematically performed before CUS surgery, which consisted of Monti or Mitrofanoff derivations associated with augmentation ileo-cystoplasty. 7 Pre-surgical ULR clinical visit was composed of standardized assessments and time for education and questions. Patient objectives for ULR procedure consisted of improvement in hand function and ISC acquisition through the native urethra for males and via CUS for females.…”

“…The problem of urethral access can be resolved by formation of a continent urinary stoma (CUS) (or diversion) through various surgical techniques, which are performed after an ISC simulation test in rehabilitation units. 6,7 Studies have shown that C6 ASIA injury level is the highest level to enable ISC, but in a very low proportion of patients. The overall success for ISC ranges from 20 to 30% in the whole tetraplegic population.…”