Bladder Management Table 13 Continent Catheterizable Stoma and Incontinent Urinary Diversion

Author Year
Country
Score
Research Design
Total Sample Size

Methods

Outcome

Continent Catheterizable Stoma

Karsenty et al. 2008
France
Pre-Post
N=13

Population: Mean age: 42 yr; Gender: males=2, females=11; Level of injury: cervical=5, thoracic=5, sacral=1. cauda equina=1 other=1; All were unable to self catheterize. Mean time since injury=12.2 yr; Mean follow-up=44 mo.
Treatment: Patients underwent a novel procedure involving a cutaneous continent diversion composed of an abdominal continent stoma combined with enterocystoplasty was used to facilitate self-catheterization.
Outcome Measures: Complications, continence, catheterization difficulties, functional bladder capacity and serum creatinine.

  1. Complications included postoperative infections (5 urinary, 2 pulmonary) and 1 pelvic abscess and 1 small bowel occlusion both requiring surgery
  2. In all patients, the catheterizable stoma was continent, but 3 females had stress leakage through native urethra, 2 requiring secondary bladder neck closure.
  3. All patients could self catheterize.
  4. An increase from 180ml to 540ml was seen in functional bladder capacity from pre to post surgery.
  5. No change in serum creatinine was seen post surgery.

Hakenberg et al. 2001
Germany
Case series
N=5

Population: Mean age=31 yr; Gender: males=1, females=4; Level of injury: tetraplegia=5; Mean time since injury=22 months. F/U 21–40 mo. All patients on anticholinergics both pre and post surgery.
Treatment: Patients underwent appendicovesicostomy and a cutaneous stoma was placed in the lower right abdominal quadrant.
Outcome Measures: Independent CIC, Stomal stenosis, urinary tract infections, satisfaction.

  1. All patients were able to independently perform CIC and were continent.
  2. Stomal stenosis did not occur
  3. 2 patients experienced urinary tract infections once, and 1 patient had repeated occurrences.
  4. 3 out of 5 patients were highly satisfied with the results.
  5. Post-op bladder compliance 20–44 mm H20

 

Sylora et al. 1997
USA
Pre-Post
N=7

Population: Age=19 to 44 yr; Gender: males=4, females=3; Level of injury: tetraplegia=7. All patients had adequate bladder capacity and were on anticholinergics
Treatment: Patients underwent Mitrofanoff umbilical apendicovesicostomy with appendix or ileum. F/U 5–20 mo.
Outcome Measures: Bladder capacity, continence, complications.

  1. No significant changes were seen in bladder capacity.
  2. All patients were continent.
  3. Complications included:
  • 1 patient had transient stress urinary incontinence which resolved spontaneously.
  • 1 patient required stomal revision.

Incontinent Urinary Diversion

Peterson et al. 2012
USA
Case Series
N=3051

Population: Ileal loop urinary diversion=1919, Bladder augmentation=1132; Mean age: 40 yr.
Treatment: Review of patients’ information undergoing either ileal loop urinary diversion or bladder augmentation.
Outcome Measures: Sociodemographic characteristics and care settings.

  1. Patients who had ileal loop diversions were older than those who received bladder augmentation (mean age of 46 versus 34 yr p<0.001).
  2. Ileal loop diversion patients were most likely to have Medicare as the primary payer, whereas private insurance was used most among bladder augmentation (p<0.001).
  3. Patients were more likely to get bladder augmentation at teaching institutions than those at non-teaching institutions (42% versus 23%; p<0.001).
  4. Ileal loop diversions required longer LOS and used more healthcare resources than bladder augmentation. More likely to be discharged to home healthcare (37.0% versus 23.6%; p<0.001).

 

Colli & Lloyd 2011
USA
Case Series
N=35

Population: Mean age: 44.7 yr (range=25-78 yr); Gender: male=11, female=24; mean LOS=4.1 d; Etiology of injury: SCI=77, MS=5, Cerebrovascular accident=3; Abdominal BNC=31; Transvaginal bladder neck closure=4; Mean follow up=27 mo.
Treatment: Bladder neck closure (BNC).
Outcome Measures: Renal functions measure, complication rate.

  1. Indications for BNC included: severe urethral erosion (80%), decuitus ulcer (40%), urethrocutaneous fistula (11%), and severe incontinence (9%). Most patients reported multiple indications for surgery.
  2. Overall, the complications rate was 16.7%.

Zommick et al. 2003
USA
Case Series
N=21

Population: Age Range 17-51 yr; Gender: males=12, females=9; Level of injury=Cervical Spine.
Treatment: Review of charts, and patients contacted by independent reviewer to determine satisfaction and quality of life (QoL) after lower urinary tract reconstruction.
Outcome Measures: Visual Analogue Scale measuring satisfaction, nonvalidated QoL questionnaires.

  1. 68% reported improved QoL after bladder reconstruction.
  2. Satisfaction was high in most patients (8 ≥ out of 10), with lower ratings relating to complications that arose.

Kato et al. 2002
Japan
Case Series
N=16

Population: SCI: Mean Age: 46 yr; Gender: males=13, females=3; Level of injury: tetraplegia; Mean follow-up time=8.7yr.
Treatment: Follow-up evaluation of those having ileal conduit formation.
Outcome Measures: Review of charts (deaths, complications, subjective statements of satisfaction, serum creatinine where completed).

  1. No statistical comparisons reported.
  2. Serum creatinine remained stable.
  3. 3 subjects died (constrictive ileus, unknown, septicemia associated with UTIs) during the follow-up period.
  4. 5/16 patients had calculus formation in the upper urinary tract; 3 had severe UTI’s as a result.
  5. 8 subjects of 13 in whom a bladder was initially preserved sustained a pyocyst.
  6. 5 experienced calculus formation in the upper urinary tract, 3 of these having severe UTIs as a result..
  7. Most patients were more satisfied with procedure than previous management method upon survey a few months after operation (no long-term follow-up on this issue).

Chartier-Kastler et al. 2002
France
Case Series
N=33

Population: MS (N=4), CP (N=3), Myelitis (N=3), Other (N=2), SCI (N=21): Mean Age=40.6 yr; Gender: males=14, females=19; Level of injury: cervical=32, thoracic=25, C1-T10=14, T11-L1=6, below L2=1; Severity of injury: complete, incomplete; Mean follow-up=48 mo.
Treatment: Follow-up evaluation of those having cutaneous ileal conduit (ileo-ureterostomy) diversion.
Outcome Measures: IVU, serum creatinine, cystoscopy, urine cultures and pre/post incidence of UTIs, visual analog patient satisfaction. Collected at follow-up as indicated above.

  1. No statistical comparisons reported
  2. Initial surgery was successful. All patients became continent after initially being incontinent prior to surgery.
  3. Of 17 with pre-op hydronephrenosis, 10 showed a decrease or disappearance.
  4. 12 patients developed one or more complications during follow-up. 4 early complications and 13 late complications.
  5. Most prevalent long-term complications were pyocystitis (4–3 requiring cystectomy), pyelonephritis (4) and urethral leak (2).
  6. Satisfaction survey indicated none regretted surgery (9.1±2.8 out of 10).

Craven & Etchells 1998 Australia
Case Series
N=27

Population: SCI patients with ileostomy, colostomy, or urostomy.
Treatment: No treatment – chart review
Outcome Measures: Questionnaire for physical, psychological, and lifestyle effects after surgery.

  • 11 patients underwent urostomy (Indications: chronic UTI in all, 1 recurrent calculi, 3 hydronephrosis)
  • Three patients required cyctectomy, while a fourth was advised to get one
  • Although 27 charts reviewed only 18 patients located to complete the questionnaire:
  1. Bowel and bladder management greatly improved in most cases, resulting in improved quality of life for these patients.
  2. Positive psychological effects.
  • Long-term impact on renal health not assessed.

Note: CIC=Clean Intermitent Catheterization; IVU=Intravenous Urography; UTI=Urinary Tract Infection

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