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Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: long-term functional results.

Abstract

AIMS

To study clinical and urodynamic data along with immediate and long-term morbidity of surgical management of neurogenic bladder in spinal cord injury (SCI) patients

METHODS

Single-center retrospective study of 61 SCI patients with neurogenic detrusor overactivity (NDO) related urinary incontinence and/or sphincter weakness incontinence who underwent supratrigonal cystectomy with Hautmann pouch ± concomitant stress incontinence procedure (27.9%; n = 17).

RESULTS

With a mean follow-up of 5.84 years (range 1-20.5) an improved or total continence rate was achieved in 89.7% and 74.1%, respectively. Surgery failed (incontinence persisted) for six (10.3%) patients, three of which had a simultaneous procedure for stress incontinence. On urodynamics, maximum cystometric capacity (MCC) (ml) increased from 305.2 to 509.4 (P < 0.05), mean compliance (ml/cmH(2) O) increased from 15 to 42.7 (P < 0.05) and mean detrusor pressure at MCC (cmH(2) O) fell from 54.1 to 19.1 (P < 0.05). Persisent NDO occurred in 20.7% compared to 59% pre-operatively (P < 0.05). The overall complication rate was 37.7% but ≤Clavien grade 2 in 82.6%. Notably, the incidence of bowel dysfunction, namely diarrhea and/or fecal incontinence was 27.5%. Concomitant outlet surgery was associated with increased morbidity as three (17.6%) complications led to re-intervention.

CONCLUSIONS

Supratrigonal cystectomy with Hautmann pouch is an excellent surgical treatment for SCI patients suffering from refractory NDO incontinence. It achieves the main goals of achieving continence (74% complete), reducing rates of infection and preserving upper tract function, which is reflected in the improvement on urodynamics. The incidence of secondary bowel dysfunction and potential risk of a simultaneous procedure for stress incontinence needs to be discussed.

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  • Authors+Show Affiliations

    ,

    Department of Urology, Groupe Hospitalier Pitié-Salpétrière, Paris, AP-HP, Medical School Pierre et Marie Curie, Paris VI University, Paris, France.

    , , , ,

    Source

    Neurourology and urodynamics 31:5 2012 Jun pg 672-6

    MeSH

    Adolescent
    Adult
    Aged
    Chi-Square Distribution
    Cholinergic Antagonists
    Cystectomy
    Diarrhea
    Fecal Incontinence
    Female
    France
    Humans
    Ileum
    Male
    Middle Aged
    Pressure
    Recovery of Function
    Reoperation
    Retrospective Studies
    Spinal Cord Injuries
    Surgically-Created Structures
    Time Factors
    Treatment Outcome
    Urinary Bladder
    Urinary Bladder, Neurogenic
    Urinary Bladder, Overactive
    Urinary Incontinence
    Urodynamics
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22532256

    Citation

    Gobeaux, Nicolas, et al. "Supratrigonal Cystectomy With Hautmann Pouch as Treatment for Neurogenic Bladder in Spinal Cord Injury Patients: Long-term Functional Results." Neurourology and Urodynamics, vol. 31, no. 5, 2012, pp. 672-6.
    Gobeaux N, Yates DR, Denys P, et al. Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: long-term functional results. Neurourol Urodyn. 2012;31(5):672-6.
    Gobeaux, N., Yates, D. R., Denys, P., Even-Schneider, A., Richard, F., & Chartier-Kastler, E. (2012). Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: long-term functional results. Neurourology and Urodynamics, 31(5), pp. 672-6. doi:10.1002/nau.21239.
    Gobeaux N, et al. Supratrigonal Cystectomy With Hautmann Pouch as Treatment for Neurogenic Bladder in Spinal Cord Injury Patients: Long-term Functional Results. Neurourol Urodyn. 2012;31(5):672-6. PubMed PMID: 22532256.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: long-term functional results. AU - Gobeaux,Nicolas, AU - Yates,David R, AU - Denys,Pierre, AU - Even-Schneider,Alexia, AU - Richard,Francois, AU - Chartier-Kastler,Emmanuel, Y1 - 2012/04/24/ PY - 2011/07/17/received PY - 2011/10/24/accepted PY - 2012/4/26/entrez PY - 2012/4/26/pubmed PY - 2012/10/24/medline SP - 672 EP - 6 JF - Neurourology and urodynamics JO - Neurourol. Urodyn. VL - 31 IS - 5 N2 - AIMS: To study clinical and urodynamic data along with immediate and long-term morbidity of surgical management of neurogenic bladder in spinal cord injury (SCI) patients METHODS: Single-center retrospective study of 61 SCI patients with neurogenic detrusor overactivity (NDO) related urinary incontinence and/or sphincter weakness incontinence who underwent supratrigonal cystectomy with Hautmann pouch ± concomitant stress incontinence procedure (27.9%; n = 17). RESULTS: With a mean follow-up of 5.84 years (range 1-20.5) an improved or total continence rate was achieved in 89.7% and 74.1%, respectively. Surgery failed (incontinence persisted) for six (10.3%) patients, three of which had a simultaneous procedure for stress incontinence. On urodynamics, maximum cystometric capacity (MCC) (ml) increased from 305.2 to 509.4 (P < 0.05), mean compliance (ml/cmH(2) O) increased from 15 to 42.7 (P < 0.05) and mean detrusor pressure at MCC (cmH(2) O) fell from 54.1 to 19.1 (P < 0.05). Persisent NDO occurred in 20.7% compared to 59% pre-operatively (P < 0.05). The overall complication rate was 37.7% but ≤Clavien grade 2 in 82.6%. Notably, the incidence of bowel dysfunction, namely diarrhea and/or fecal incontinence was 27.5%. Concomitant outlet surgery was associated with increased morbidity as three (17.6%) complications led to re-intervention. CONCLUSIONS: Supratrigonal cystectomy with Hautmann pouch is an excellent surgical treatment for SCI patients suffering from refractory NDO incontinence. It achieves the main goals of achieving continence (74% complete), reducing rates of infection and preserving upper tract function, which is reflected in the improvement on urodynamics. The incidence of secondary bowel dysfunction and potential risk of a simultaneous procedure for stress incontinence needs to be discussed. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/22532256/Supratrigonal_cystectomy_with_Hautmann_pouch_as_treatment_for_neurogenic_bladder_in_spinal_cord_injury_patients:_long_term_functional_results_ L2 - https://doi.org/10.1002/nau.21239 DB - PRIME DP - Unbound Medicine ER -