Transvaginal closure of urethra and correction of uterovaginal prolapse in neurologically impaired patient with chronic indwelling catheter

Kubal, Uma; Arunkalaivanan, Angamuthu; Baptiste, Monica

doi:10.1007/s00192-008-0797-2

Cited by 2 publications

(5 citation statements)

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“…Postoperative detrusor spasms represent a significant concern because they could probably increase the rate of fistula formation and postoperative incontinence. During the initial postoperative period, it is critical to continue the treatment with anticholinergics and/or β 3 adrenoceptor agonists [ 10 , 11 ]. The transvaginal closure of urethra and anterior colporrhaphy ensure low morbidity and high success rates.…”

Section: Discussionmentioning

confidence: 99%

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Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

et al. 2021

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Background Chronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter. Case presentation We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery. Conclusion This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.

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Section: Discussionmentioning

confidence: 99%

“…At long-term follow-up of this procedure, 50% of the women were dry after the initial operation. Other complications encountered were bladder stones (21%), leakage around the catheter (17%), recurrent catheter blockage (10%), and urinary tract infections [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

et al. 2021

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“…Of the 13 patients who still experienced incontinence, 12 underwent a subsequent operation that eventually yielded seven patients with clinical continence. The long-term complications included eight with pericatheter leakage, ten with bladder stones, four with recurrent urinary tract infections, and five with recurrent catheter obstruction [4]. Zimmerman described a modified transvaginal bladder neck closure with 100% success rate in six patients; however, his technique was not reproducible as Nielson reported a 20% fistula rate with the same approach in 5 patients [10].…”

Section: Discussionmentioning

confidence: 99%

“…In many instances, this common practice of upsizing catheter size or balloon volume leads to an incompetent and destroyed urethra necessitating change to another form of management or lower urinary tract reconstructive surgery. [1,2,4] Surgical management of the destroyed female urethra secondary to chronic indwelling urethral catheterization is often compounded by medical comorbidities, poor nutritional status, and limited functional capacity. Options include supravesical diversion, attempted functional closure with a tight pubovaginal sling if there is enough preserved urethra, and transabdominal or transvaginal bladder neck closure with an incontinent ileovesicostomy, continent catheterizable stoma or suprapubic catheter (cystostomy) placement [2,3,5].…”

Section: Introductionmentioning

confidence: 99%

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Transvaginal Bladder Neck Closure Revisited: A Less Invasive Approach to the Management of a Destroyed Urethra

2013

J Androl Gynaecol

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Introduction: An inevitable consequence of chronically urethral catheterized female patients with a neurogenic bladder is an incompetent urethra leading to leakage around the catheter. This is often managed by increasing the catheter size and/or the volume in the retaining balloon. Eventually these common practices lead to further urethral dilation and an incompetent urethra. The social embarrassment and skin breakdown from the incontinence can place significant demands on the patient and/or caregiver. Eventually this process of chronic urethral dilation leads to a destroyed urethra. Surgical options for this unique patient population is often compounded by medical comorbidities, obesity, poor nutritional status, and limited functional capacity [1]. Bladder neck suspension and suburethral slings are insufficient at providing continence thereby making bladder neck closure and suprapubic catheter placement a feasible alternative. Transabdominal bladder neck closure has been reported to have a lower risk of failure; however, it also has increased morbidity [2]. Transvaginal bladder neck closure affords a less invasive approach to a complex problem with quicker recovery while achieving satisfactory clinical continence in this difficult group of patients [1,3]. Study design, materials and methods:A retrospective analysis was performed in a cohort of female patients who had undergone transvaginal bladder neck and suprapubic catheter placement at a single institution by a single surgeon. All patients had an incompetent urethra secondary to the use of a chronic indwelling urethral catheter manifested by leakage around the catheter. Data reviewed included demographics, cause of neurogenic bladder, medical comorbidities, and length of hospital stay, complications, and clinical continence.Results: Five patients underwent transvaginal bladder neck closure and suprapubic catheter placement. The etiology of neurogenic bladder included spinal cord injury secondary to MVC, multiple sclerosis, and pathologic fracture of the spine. Average age and length of foley catheter use was 41.2 years and 6.2 years, respectively. Hospital stay averaged 3.2 days with a range of 1-7 days. 80% of patients were clinically continent with a mean post operative follow-up of 8.2 months. One of these patients had an improvement in incontinence, but is now clinically dry after a following operation.Conclusions: Transabdominal bladder neck closure has been described in the literature to have a lower risk of fistulas and failure; however, it carries increased morbidity and hospital stay in a patient population with multiple complex medical problems. Transvaginal bladder neck closure has been described in the literature to have a failure rate of 17 to 60% with patients developing fistulas and florid incontinence [1,2]. In our experience, transvaginal bladder neck closure and suprapubic tube placement affords a less invasive approach to the incompetent urethra with a mean hospital stay of 3.2 days while achieving clinical continence. Transvaginal bladder ...

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Transvaginal closure of urethra and correction of uterovaginal prolapse in neurologically impaired patient with chronic indwelling catheter

Cited by 2 publications

References 4 publications

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

Transvaginal Bladder Neck Closure Revisited: A Less Invasive Approach to the Management of a Destroyed Urethra

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