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Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction.

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.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

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

    ,

    Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.

    Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.

    Source

    Neurourology and urodynamics 35:2 2016 Feb pg 260-6

    MeSH

    Adolescent
    Adult
    Compliance
    Cystectomy
    Female
    Humans
    Lower Urinary Tract Symptoms
    Male
    Middle Aged
    Pressure
    Reconstructive Surgical Procedures
    Recovery of Function
    Retrospective Studies
    Spinal Cord Injuries
    Time Factors
    Treatment Outcome
    Urinary Bladder
    Urinary Bladder, Neurogenic
    Urodynamics
    Young Adult

    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 -