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Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction.
Neurourol Urodyn 2016; 35(2):260-6NU

Abstract

AIMS

To investigate the functional outcome after supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction (NLUTD).

METHODS

Retrospective follow-up investigation in a single spinal cord injury rehabilitation center. In 29 patients, urodynamic data before and after supratrigonal cystectomy and augmentation ileocystoplasty, clinical outcome and post-operative complications were evaluated.

RESULTS

The median age of the 29 patients at the time of surgery was 31 years, a median 14 years after NLUTD had occurred. At the last follow-up visit (median 2.4, range 0.4-9.0 years post-operatively), 20/29 patients (69%) were continent compared to 2/29 pre-operatively (P = 0.001). Furthermore, 16 patients required no or less detrusor relaxation therapy after augmentation ileocystoplasty. Augmentation cystoplasty resulted in a significant (P = 0.001) increase in the median bladder capacity (from 240 ml to 500 ml) and compliance (from 13 ml/cm H2 O to 50 ml/cm H2 O). The median maximum detrusor pressure had decreased significantly (P = 0.001) from 38 cm H2 O to 15 cm H2 O. Significantly (P = 0.001) fewer patients presented with a risk for renal damage (1 vs. 15 with maximum detrusor pressure >40 cm H2 O and 1 vs. 12 with detrusor compliance <20 ml/cm H2 O) at the last follow-up. The following complications were observed in 11/29 (38%) patients: paralytic and obstructive ileus, impaired bowel function, bladder stones, dehiscence, metabolic acidosis and autonomic dysreflexia.

CONCLUSIONS

Protection of renal function, adequate bladder capacity and low detrusor pressure can be achieved using supratrigonal cystectomy and augmentation ileocystoplasty in patients suffering from refractory NLUTD.

Authors+Show Affiliations

Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25524480

Citation

Krebs, Jörg, et al. "Functional Outcome of Supratrigonal Cystectomy and Augmentation Ileocystoplasty in Adult Patients With Refractory Neurogenic Lower Urinary Tract Dysfunction." Neurourology and Urodynamics, vol. 35, no. 2, 2016, pp. 260-6.
Krebs J, Bartel P, Pannek J. Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction. Neurourol Urodyn. 2016;35(2):260-6.
Krebs, J., Bartel, P., & Pannek, J. (2016). Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction. Neurourology and Urodynamics, 35(2), pp. 260-6. doi:10.1002/nau.22709.
Krebs J, Bartel P, Pannek J. Functional Outcome of Supratrigonal Cystectomy and Augmentation Ileocystoplasty in Adult Patients With Refractory Neurogenic Lower Urinary Tract Dysfunction. Neurourol Urodyn. 2016;35(2):260-6. PubMed PMID: 25524480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction. AU - Krebs,Jörg, AU - Bartel,Peter, AU - Pannek,Jürgen, Y1 - 2014/12/18/ PY - 2014/06/30/received PY - 2014/10/23/accepted PY - 2014/12/20/entrez PY - 2014/12/20/pubmed PY - 2016/12/15/medline KW - augmentation ileocystoplasty KW - complications KW - neurogenic lower urinary tract dysfunction KW - urinary continence KW - urodynamics SP - 260 EP - 6 JF - Neurourology and urodynamics JO - Neurourol. Urodyn. VL - 35 IS - 2 N2 - AIMS: To investigate the functional outcome after supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction (NLUTD). METHODS: Retrospective follow-up investigation in a single spinal cord injury rehabilitation center. In 29 patients, urodynamic data before and after supratrigonal cystectomy and augmentation ileocystoplasty, clinical outcome and post-operative complications were evaluated. RESULTS: The median age of the 29 patients at the time of surgery was 31 years, a median 14 years after NLUTD had occurred. At the last follow-up visit (median 2.4, range 0.4-9.0 years post-operatively), 20/29 patients (69%) were continent compared to 2/29 pre-operatively (P = 0.001). Furthermore, 16 patients required no or less detrusor relaxation therapy after augmentation ileocystoplasty. Augmentation cystoplasty resulted in a significant (P = 0.001) increase in the median bladder capacity (from 240 ml to 500 ml) and compliance (from 13 ml/cm H2 O to 50 ml/cm H2 O). The median maximum detrusor pressure had decreased significantly (P = 0.001) from 38 cm H2 O to 15 cm H2 O. Significantly (P = 0.001) fewer patients presented with a risk for renal damage (1 vs. 15 with maximum detrusor pressure >40 cm H2 O and 1 vs. 12 with detrusor compliance <20 ml/cm H2 O) at the last follow-up. The following complications were observed in 11/29 (38%) patients: paralytic and obstructive ileus, impaired bowel function, bladder stones, dehiscence, metabolic acidosis and autonomic dysreflexia. CONCLUSIONS: Protection of renal function, adequate bladder capacity and low detrusor pressure can be achieved using supratrigonal cystectomy and augmentation ileocystoplasty in patients suffering from refractory NLUTD. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/25524480/Functional_outcome_of_supratrigonal_cystectomy_and_augmentation_ileocystoplasty_in_adult_patients_with_refractory_neurogenic_lower_urinary_tract_dysfunction_ L2 - https://doi.org/10.1002/nau.22709 DB - PRIME DP - Unbound Medicine ER -