Perforation of Continent Urinary Reservoirs Scandinavian Experience

Abstract

In a questionnaire survey of urological departments in Sweden, Denmark, Finland and Norway, 20 episodes of perforation of continent urinary pouches were found to have occurred in 18 patients, representing an incidence of 1.5%. This complication occurred with ileal as well as colonic segments, without predilection. In one case there was perforation of an appendiceal outlet. Noticeable findings were (a) a long delay (median 10h) to treatment and (b) that investigational procedures such as enterocystography and enterocystoscopy were not commonly employed. Treatment of this potentially lethal complication was by oversewing the perforation, and there were no subsequent major complications. This complication should be strongly suspected if a patient with continent urinary reconstruction presents with acute abdominal pain.

Continent cutaneous urinary diversion in patients with spinal cord injury

“…This is a serous complication with an incidence of a few per cent after all types of intestinal reservoir for urine storage. 7 It often occurred during the night since this is the longest interval between emptying of the reservoir. Theoretically, the risk of perforation during the night is higher for patients in a wheelchair as some of these patients have problems with water retention in the legs during the day.…”

“…The prevalence of a natural safety valve against high pressure, however, does not completely eliminate the risk of perforation since this complication also occurs in patients with orthotopic bladders after cystectomy for bladder carcinoma. 7 Patients with a level of lesion above T5 run the risk of developing AD -a syndrome characterized by a generalized vasoconstriction below lesion level, inducing a huge increase in blood pressure, sweating above the lesion level and a pounding headache. 8,9 The reaction is elicited by stimuli arising below the lesion level and irritations in the urinary bladder are very potent stimuli for this generalized reaction.…”

Diagnosing spontaneous ileal neobladder perforation: Too often delayed

“…False negative results are likely due to the fact that these patients are usually seen first by non-urologists and the cystography was Ileal neobladder perforation the diagnostic modality of choice. 5 We suggest that in order to decrease the time to diagnosis, triage nurses and non-urologist physicians should be aware of this pathology and have a high index of suspicion. Moreover, patients with urinary reservoirs presenting to the emergency room with abdominal pain should be examined by an urologist upon arrival.…”

“…5 We suggest that in order to decrease the time to diagnosis, triage nurses and non-urologist physicians should be aware of this pathology and have a high index of suspicion. Moreover, patients with urinary reservoirs presenting to the emergency room with abdominal pain should be examined by an urologist upon arrival.…”

Rotura recurrente de neovejiga ileal: manejo conservador

“…Otras causas menos probables son la presencia de adherencias intraperitoneales a la neovejiga, que pueden causar desgarros durante los episodios de sobredistensión 1 , o lesiones directas de la pared intestinal por mala técnica de autosondaje (tenerse en cuenta cuando hay hematuria simultánea al sondaje) 12 . Las líneas de sutura de la neovejiga no parecen ser un punto débil en el que se produzcan más frecuentemente roturas 2,6,13 .…”