Detaillierte Beitrags-Information

Zurück zur Liste

Beitragstitel Bladder neck/urethral closure in women using a continent cutaneous diversion and suffering refractory urethral urinary incontinence
Beitragscode M009
Autor:innen
  1. Nuno Grilo CHUV Centre Hospitalier Universitaire Vaudois (CHUV) Präsentierende:r
  2. Véronique Phé Médecine Sorbonne Université, Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris
  3. Fabiana Cancrini Sant’Andrea Hospital, Sapienza University of Rome
  4. Christine Reus Karolinska Institutet
  5. Emmanuel Chartier-Kastler Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI
Präsentationsform Freie Mitteilungen
Themengebiete
  • Unterer Harntrakt
Abstract-Text Aim
The objective of this study is to analyze the outcome of bladder neck/urethral closure as a treatment option for neurogenic and malformative stress incontinence in women with a continent cutaneous diversion (CCD).

Methods
This single-center historic database included 233 patients (167 females and 66 males) with a CCD, performed between 2001 and 2017. Fourteen female patients underwent a bladder neck/urethral closure. Data on patient and surgical characteristics, previous stress incontinence surgeries and full urethral continence at last follow-up were analyzed.

Results
A total of 10 transabdominal and 4 transvaginal bladder neck/urethral closure procedures were performed. Seven of the 14 patients failed previous stress urinary incontinence procedure before undergoing bladder neck/urethral closure. From the 7 patients with no prior history of anti-incontinence surgery, 3 presented bladder neck and urethral destruction due to long term indwelling catheter, 2 presented extensive urethral fibrosis owed to multiple reconstructive procedures in childhood and another underwent a previous cervicotomy. Six patients underwent concomitant supratrigonal cystectomy with augmentation cystoplasty and CCD at the time of bladder neck/urethral closure and one underwent a CCD without augmentation cystoplasty, whilst another had a CCD revision. Bladder neck/urethral closure alone was performed in another six patients.
There were no major procedure-related complications. One patient presented an early vesicovaginal fistula 18 days postoperatively. Resolution was achieved after 3 months of conservative management with a suprapubic catheter.
After a median follow-up of 5,4 years, three patients required a CCD revision and 1 patient needed an endoscopic followed by 2 open cystolitholapaxy at a later stage.
At last follow-up, urethral continence was achieved in all 14 patients, with only one necessitating an additional vesicovaginal fistula repair with a Martius flap. A multiple sclerosis patient underwent an ileal conduit due to significant upper limb function loss 7 years after bladder neck closure.

Conclusions
In summary, achieving urethral continence is challenging but crucial for the management of patients with a CCD. In our experience, bladder neck/urethral closure provided good long-term results, regardless of the surgical approach. It is, therefore, a valid option in females with a continent cutaneous diversion suffering from refractory urinary incontinence.