title: Augmentation cystoplasty and closure of the urethra for the destroyed lower urinary tract.
abstract: Five paraplegic patients with pressure ulceration complicated by incontinence related to fistula formation were treated by deliberate closure of the urethra and augmentation cystoplasty with a continent stoma. This procedure is similar in scope to urinary diversion but preserves a low-pressure reservoir and obviates the use of tubes for drainage of urine. Overall outcome was excellent. Valvular failure occurred in one patient and required revision. The follow-ups range from 1 to 5 years, with a mean of 24 months. One patient developed reservoir calculi as a late complication, necessitating removal with flexible endoscopy via the continent conduit. All patients have preserved normal upper tracts. Augmentation cystoplasty with closure of the urethra is a reasonable procedure in such patients providing for low-pressure urinary storage and permitting secondary or simultaneous plastic surgical procedures on perineal pressure ulceration and osteomyelitis.
authors.affiliation: Department of Surgery, University of Michigan.
authors.forename: J L
authors.initials: JL
authors.lastname: Wan
authors.forename: E J
authors.initials: EJ
authors.lastname: McGuire
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D010264:Paraplegia / Q000150:complications*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014548:Urinary Fistula / Q000601:surgery; D014563:Urodynamics / Q000502:physiology; D014567:Urography