[Laparoscopic cystectomy and transileal ureterostomy for neurogenic vesicosphincteric disorders. Evaluation of morbidity].
OBJECTIVE
To evaluate the morbidity and mortality of laparoscopic cystectomy combined with transileal ureterostomy to treat neurogenic vesicosphincteric disorders.


METHODS
Prospective study performed between february 2004 and april 2006 on 26 consecutive patients with a mean age of 55.0 +/- 12.7 years treated by laparoscopic cystectomy for neurogenic vesicosphincteric disorders. The underlying neurological disease was multiple sclerosis (MS) in 20 cases, spinal cord injury in 4 cases and transverse myelitis in 2 cases. The median preoperative ASA score was 3 (range: 2-3).


RESULTS
No open conversion was necessary. One intraoperative complication was observed (vascular injury). No perioperative death was observed. The nasogastric tube was maintained postoperatively for an average of 8.69 +/- 5.9 hours. The mean time to resumption of oral fluids was 1.4 +/- 0.7 days and mean time to resumption of solids was 2.6 +/- 1.0 days. The mean time to resumption of bowel movements was 3.8 +/- 3.2 days. The mean intensive care stay was 3.9 +/- 1.1 days. Two postoperative complications were observed in the same patient (ileus and bronchial congestion). Postoperative narcotic analgesics were necessary in 60% of cases. The mean hospital stay was 10.3 +/- 4.1 days. Two late postoperative complications were observed in the same patient (two episodes of pyelonephritis).


CONCLUSIONS
Laparoscopic cystectomy has a low morbidity in neurological patients, allowing early return of feeding and a moderate length of hospital stay.
Guillotreau
Julien
J
Service d'Urologie, d'Andrologie et de Transplantation Rénale, CHU Rangueil, Toulouse, France.
Gamé
Xavier
X
Castel-Lacanal
Evelyne
E
Mallet
Richard
R
De Boissezon
Xavier
X
Malavaud
Bernard
B
Marque
Philippe
P
Rischmann
Pascal
P
D003422:Critical Care; D015653:Cystectomy / Q000379:methods*; D003672:Defecation; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D007431:Intraoperative Complications; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009188:Myelitis, Transverse / Q000150:complications; D009294:Narcotics / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology; D011704:Pyelonephritis / Q000209:etiology; D013119:Spinal Cord Injuries / Q000150:complications; D013997:Time Factors; D014519:Ureterostomy / Q000379:methods*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*
D009294:Narcotics