Category: Reconstruction: Benign

MP14-1 - Laparoscopic continent urinary diversion: preliminary experience in neurogenic patients and its impact on quality of life

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Urinary dysfunction is a common feature secondary to spinal chord injury, and have a significant negative impact on the health status and quality of life (QoL) of these patients. Intermittent self-catheterization is a common solution, however, urethral meatus’ location is frequently itself a limitation for this technique. The creation of an easily accessible way for self-catheterization can increase autonomy and, subsequently, QoL.

Aim: To report our preliminary experience with laparoscopic continent urinary diversion in adult patients with neurogenic bladder caused by spinal cord injury.

Methods : From January 2014 to March 2017, 8 patients were submitted to a laparoscopic continent urinary diversion (6 with an appendicovesicostomy under Mitrofanoff procedure and 2 with an ileovesicostomy under Yang-Monti’s).  Clinical indications were patients with difficulties to access urethral meatus, secondary to its motor disability (3 paraplegic patients, 4 tetraplegic after surgical rehabilitation of the upper limb and 1 with dysraphism) but with proper dexterity. Before surgery, bladder emptying was obtained by hetero-catheterization (5), self-catheterization with need of transferring (2), stimulation by Brindley technique (1). Only one patient was submitted to a concomitant augmentation enterocystoplasty (detrusorian hyperactivity refractory to medical treatment).

Results :

The mean follow-up period was 21.5±11,9 months.In 7 patients, stoma was positioned in umbilicus, and 1 in right iliac fossa. There was no conversion to laparotomy and none early postoperative complication. Continence rate was 67,5% (1 month), and 100% (12 months) - 3 patients needed a mid-urethral sling (at average 6th month post-op) to manage a stress urinary incontinence, and 2 needed increased dose of anti-cholinergics to control its detrusorian hyperactivity. Other late postoperative complications were: 6 stoma stenosis (1 needing surgical revision and the others solved with a stopper) and 1 bladder stone (solved by endoscopic approach).

Conclusions : This series shows that laparoscopic approach for continent urinary diversions is feasible and safe in adult patients with neurogenic bladder, maintaining its positive impact on autonomization (catheterization autonomous and with increased frequency, less daily transfers) and subsequently on QoL.

Pedro Costa

Urology resident
Urology Department, Clinique du Pré, Le Mans, France
V.N.Gaia, Porto, Portugal

Pedro Costa, MD
Urologist in Centro Hospitalar de Vila Nova de Gaia / Espinho

Pierre-Emmanuel Bryckaert

Urology Department, Clinique du Pré, Le Mans, France
Le Mans, Pays de la Loire, France

Carlos Ferreira

Urology Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Portugal
Matosinhos, Porto, Portugal