Outcome of urethral closure in patients with neurologic impairment and complete urethral destruction.
OBJECTIVE
The purpose of this study is to describe the problems associated with prolonged urethral catheterization in 12 patients with neurological problems and to report the results of surgical treatment.


METHODS
A retrospective study of patients with neurogenic bladder and urethral dysfunction treated with prolonged catheterization resulting in incontinence associated with loss of urethral tissue and or function selected 12 patients. All had video urodynamics. Twelve were continuously incontinent despite a catheter. Bladder compliance, where that could be measured, was low is 10, and there were multiple and serious co-morbidities including sepsis, hypoalbuminemia, skin breakdown, osteomyelitis, respiratory insuffiency, etc. There were 4 males and 8 females, 9 had a spinal cord injury and 3 progressive multiple sclerosis.


RESULTS
Male patients underwent transperineal closure of the membranous urethra; females transvaginal closure of the urethra. All patients had a urinary diversion, either an ileovesicostomy, or an augmentation cystoplasty and construction of a neourethra. Continence was ultimately achieved in 11 of 12 patients at a median 20 months. Four patients had one additional procedure to gain continence, but five patients required 3.8 procedures/patient to achieve continence. Closure of the male urethra was more easily accomplished than closure of an extensively damaged eroded female urethra.


CONCLUSIONS
Patients with urethral damage and erosion related to prolonged catheter present a formidable challenge in surgical reconstruction. Most have serious co-mobidities and a single operation does not usually solve all the problems. Persistence does almost always result in continence.
Stoffel
John T
JT
Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA.
McGuire
Edward J
EJ
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000503:physiopathology*; D012189:Retrospective Studies; D012727:Sex Characteristics; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000601:surgery; D014546:Urinary Catheterization / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000601:surgery; D013520:Urologic Surgical Procedures