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Continent ileovesicostomy after bladder neck closure as salvage procedure for intractable incontinence.

Kranz J, Anheuser P, Rausch S, Fechner G, Braun M, Müller SC, Steffens JA, Kälble T - Cent European J Urol (2014)

Bottom Line: Primary BNC was successful in all patients and primary continence rate was 86.7%.Regardless of the number of revisions, at the last follow-up 93.3% of patients had a functional channel.All complications occurred within the first postoperative year.

View Article: PubMed Central - PubMed

Affiliation: St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany ; The selected authors contributed equally to this work.

ABSTRACT

Introduction: We evaluated the success rate of continent vesicostomy using an ileal segment with seroserosally embedded, tapered ileum for bladder augmentation with continent stoma following bladder neck closure (BNC) for severely damaged bladders or persistent urinary incontinence.

Material and methods: A total of 15 patients were treated for persistent urinary incontinence or non-reconstructible bladder outlet between 2003 and 2012. Underlying diagnosis included post-prostatectomy incontinence (n = 5), recurrent bladder neck stenosis (n = 5), neurogenic bladder (n = 3), urethral tumor recurrence following orthotopic neobladder (n = 1) and post-TVT and colposuspension incontinence (n = 1). All patients underwent open BNC, omental interposition and continent vesicoileostomy. The continent outlet was placed in the lower abdomen using a circumferential subcutaneous and skin plasty to avoid retraction. Data collected included age, underlying diagnosis, stoma site, time to complications and need for subsequent surgical revisions. All patients received a standardized questionnaire at the time of data acquisition and were personally interviewed.

Results: Median follow-up was 24 months (range: 2-111). Primary BNC was successful in all patients and primary continence rate was 86.7%. Two patients (13.3%) suffered from failure of the continence mechanism, caused by stoma stenosis at skin level and insufficiency of the bladder augmentation and stoma due to local infection. One additional patient developed a mild stomal incontinence without need for further reconstruction. Regardless of the number of revisions, at the last follow-up 93.3% of patients had a functional channel. All complications occurred within the first postoperative year.

Conclusions: This technique is an effective last resort treatment for patients with non-reconstructible bladder outlet.

No MeSH data available.


Related in: MedlinePlus

The efferent ileum-segment is placed at the lower abdominal quadrant. The stoma location depends on its length and mobility. It should be carefully planned to allow easy access by the patient, preferably with the dominant hand. For tension-free channel fixation, a circumferential incision is made to minimize the stricture risk. The skin flaps are mobilised down to the rectus fascia and sutured with the stoma margins with single sutures.
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Figure 0007: The efferent ileum-segment is placed at the lower abdominal quadrant. The stoma location depends on its length and mobility. It should be carefully planned to allow easy access by the patient, preferably with the dominant hand. For tension-free channel fixation, a circumferential incision is made to minimize the stricture risk. The skin flaps are mobilised down to the rectus fascia and sutured with the stoma margins with single sutures.

Mentions: Access is gained via an abdominal midline incision [11, 12]. The bladder neck is dissected, all scar tissue is excised and the ureters are stented. The bladder neck is closed in a two layered fashion using absorbable 5–zero Monocryl for the mucosa and absorbable 3–zero Monocryl for the seromuscularis. Additionally, omental interposition is performed to minimize fistula formation. The bladder is opened at the dorsocranial aspect. Thereafter, the ileal U with seroserosally embedded, tapered ileum is created as described and sewn to the opening of the bladder, as in an ileocystoplasty (Figures 1A–H). The continent stoma is placed in the lower abdomen using a circumferential subcutaneous and skin plasty (Figure 1I).


Continent ileovesicostomy after bladder neck closure as salvage procedure for intractable incontinence.

Kranz J, Anheuser P, Rausch S, Fechner G, Braun M, Müller SC, Steffens JA, Kälble T - Cent European J Urol (2014)

The efferent ileum-segment is placed at the lower abdominal quadrant. The stoma location depends on its length and mobility. It should be carefully planned to allow easy access by the patient, preferably with the dominant hand. For tension-free channel fixation, a circumferential incision is made to minimize the stricture risk. The skin flaps are mobilised down to the rectus fascia and sutured with the stoma margins with single sutures.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3992445&req=5

Figure 0007: The efferent ileum-segment is placed at the lower abdominal quadrant. The stoma location depends on its length and mobility. It should be carefully planned to allow easy access by the patient, preferably with the dominant hand. For tension-free channel fixation, a circumferential incision is made to minimize the stricture risk. The skin flaps are mobilised down to the rectus fascia and sutured with the stoma margins with single sutures.
Mentions: Access is gained via an abdominal midline incision [11, 12]. The bladder neck is dissected, all scar tissue is excised and the ureters are stented. The bladder neck is closed in a two layered fashion using absorbable 5–zero Monocryl for the mucosa and absorbable 3–zero Monocryl for the seromuscularis. Additionally, omental interposition is performed to minimize fistula formation. The bladder is opened at the dorsocranial aspect. Thereafter, the ileal U with seroserosally embedded, tapered ileum is created as described and sewn to the opening of the bladder, as in an ileocystoplasty (Figures 1A–H). The continent stoma is placed in the lower abdomen using a circumferential subcutaneous and skin plasty (Figure 1I).

Bottom Line: Primary BNC was successful in all patients and primary continence rate was 86.7%.Regardless of the number of revisions, at the last follow-up 93.3% of patients had a functional channel.All complications occurred within the first postoperative year.

View Article: PubMed Central - PubMed

Affiliation: St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany ; The selected authors contributed equally to this work.

ABSTRACT

Introduction: We evaluated the success rate of continent vesicostomy using an ileal segment with seroserosally embedded, tapered ileum for bladder augmentation with continent stoma following bladder neck closure (BNC) for severely damaged bladders or persistent urinary incontinence.

Material and methods: A total of 15 patients were treated for persistent urinary incontinence or non-reconstructible bladder outlet between 2003 and 2012. Underlying diagnosis included post-prostatectomy incontinence (n = 5), recurrent bladder neck stenosis (n = 5), neurogenic bladder (n = 3), urethral tumor recurrence following orthotopic neobladder (n = 1) and post-TVT and colposuspension incontinence (n = 1). All patients underwent open BNC, omental interposition and continent vesicoileostomy. The continent outlet was placed in the lower abdomen using a circumferential subcutaneous and skin plasty to avoid retraction. Data collected included age, underlying diagnosis, stoma site, time to complications and need for subsequent surgical revisions. All patients received a standardized questionnaire at the time of data acquisition and were personally interviewed.

Results: Median follow-up was 24 months (range: 2-111). Primary BNC was successful in all patients and primary continence rate was 86.7%. Two patients (13.3%) suffered from failure of the continence mechanism, caused by stoma stenosis at skin level and insufficiency of the bladder augmentation and stoma due to local infection. One additional patient developed a mild stomal incontinence without need for further reconstruction. Regardless of the number of revisions, at the last follow-up 93.3% of patients had a functional channel. All complications occurred within the first postoperative year.

Conclusions: This technique is an effective last resort treatment for patients with non-reconstructible bladder outlet.

No MeSH data available.


Related in: MedlinePlus