The Results of Urinary Diversion in Multiple Sclerosis

Desmond, A. D.; Shuttleworth, K. E. D.

doi:10.1111/j.1464-410x.1977.tb04190.x

Cited by 26 publications

(9 citation statements)

References 3 publications

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“…Both patients stated that the urinary stoma was easier to conceal for urine and odour than the former use of incontinence appliances. This is in keeping with other authors emphasizing that urinary diversion for incontinence may be a beneficial procedure since quality of life and sociability are likely to improve (15,16).…”

Section: Discussionsupporting

confidence: 77%

The Impact on work Ability of Ileal Conduit Urinary Diversion

Nordström

Nyman

Theorell³

1990

Scandinavian Journal of Social Medicine

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The purpose of the study was to investigate to what extent ileal conduit urinary diversion influenced patients' capacity to work. Sixty-sex urostomy patients were interviewed. Forty-seven of those were employed before surgery. Sixteen of 47 patients (34%) made permanent changes in their working conditions immediately after surgery, i.e. they did not resume work or they changed from full-time to part-time work. The working conditions changed in similar ways for another 15 patients who initially had been able to resume. Bladder cancer patients were more likely to work less than patients with incontinence/bladder dysfunction. Nineteen patients obtained disability pension either immediately after surgery or later. Eight of those considered stoma related problems, mainly leakage, as the main reason for inability to work. Diagnosis, gender, and type of work did not seem to affect the frequency of disability pension.

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Section: Discussionsupporting

confidence: 77%

The Impact on work Ability of Ileal Conduit Urinary Diversion

Nordström

Nyman

Theorell³

1990

Scandinavian Journal of Social Medicine

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“…It is important to point out that the psychological and possible physical influence of the diagnosis that necessitated cystectomy (usually bladder cancer), and the additional possible requirements for adjuvant chemotherapy or radiation therapy, is a confounding factor in this comparison of sexual function between these groups of patients. These conclusions, however, are also supported by other reports evaluating sexual activity after urinary diversion [17].…”

Section: Sexual Function and The Defunctionalized Bladdersupporting

confidence: 78%

The defunctionalized bladder

1998

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Supravesical urinary diversion without cystectomy is a common procedure performed to manage a variety of lower urinary tract pathologies. The purpose of this article is to review the complications associated with the bladder left in situ and to relate this to the female patient. Complications related to the defunctionalized bladder include pyocystis, hemorrhage, pain/spasm and neoplastic transformation. The defunctionalized bladder also has implications for sexual function, pregnancy and undiversion. The risk factors for complications are chronic infection, inadequate drainage, interstitial cystitis and previous irradiation. The incidence of neoplastic change in the defunctionalized bladder is low, but long-term follow-up is advised, as carcinoma could develop many decades after diversion. Sexual function following urinary diversion is better preserved when the bladder is retained.

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“…Unfortunately, most urologists are not yet motivated or accustomed to using conservative training methods for the treatment of NBD. Some urologists even delayed using ultrasound for the measurement of RU, and still rely on X rays [46], and recommend operations for the treatment of NBD [9,20,45,49], There are, however, some urologists who agree with us that bladder neck resections are not helpful in NBD because these resec tions either have no effect at all (if small) or they lead to incontinence (if extensive) [34], Even Guttmann [16], whom we agree with in general recommended intralumbal instillation of alcohol and bladder neck resection in some cases, procedures that have never proven helpful in our experience. Following ureterosigmoidostomy or for mation of a colon conduit there is an increased risk of malignancy [22a].…”

Section: Discussionmentioning

confidence: 99%

Efficient Treatment of Neurogenic Bladder Disorders in Multiple Sclerosis with Initial Intermittent Catheterization and Ultrasound-Controlled Training

Kornhuber

Schütz²

1990

Eur Neurol

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Out of 350 multiple sclerosis (MS) patients, 197 had residual urine (RU), on average 113 ml on admission. Treatment with initial intermittent catheterisation and bladder training normalized the neurogenic bladder disorders (NBD) in most patients; the RU was 28 ml on average at discharge. Continence improved with the reduction of RU. Even in those 37 patients with a RU of over 200 ml on admission, this management reduced the average RU to 83 ml on discharge. Patients with a RU of over 50 ml had bacteriuria 3 times more often than patients with a lower RU. In patients admitted with a long-term catheter, the catheter was removed; these patients had an average RU of 166 ml on admission, 23 ml on discharge. There was a highly significant correlation between high RU and the degree of cerebral atrophy. Patients with more than 50 ml RU at discharge were those with severe cerebral atrophy, tetraplegia and dementia. The different patterns of NBD were merely different states of the same NBD under different training conditions. Since NBD occurs about a 1,000 times more often than bowel incontinence with the same lesions in MS, it is not the cerebrospinal lesions per se, but the peripheral vicious circle they trigger, which leads to detrusor hyperactivity and dyssynergy. The peripheral pathogenetic mechanism is urinary retention leading to bladder overextension. Urodynamic investigations beyond the measurement of RU (by ultrasound) are not necessary for the treatment of NBD in most MS patients. The noninvasive and inexpensive therapy described here is effective.

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The Results of Urinary Diversion in Multiple Sclerosis

Cited by 26 publications

References 3 publications

The Impact on work Ability of Ileal Conduit Urinary Diversion

The Impact on work Ability of Ileal Conduit Urinary Diversion

The defunctionalized bladder

Efficient Treatment of Neurogenic Bladder Disorders in Multiple Sclerosis with Initial Intermittent Catheterization and Ultrasound-Controlled Training

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