Is nasogastric tube drainage required after reconstructive surgery for neurogenic bladder dysfunction?
OBJECTIVE
To determine whether the routine use of nasogastric tubes (NGTs) after bowel surgery for neurogenic bladder dysfunction improves outcomes.


METHODS
We retrospectively evaluated 54 consecutive patients (30 women, 24 men) with neurogenic bladder who underwent bladder reconstruction or replacement with bowel segments by one surgeon from December 2000 to August 2005. The first 32 [NGT(+)] had NGTs placed during the procedure, whereas the subsequent 22 [NGT(-)] did not. We compared short-term postoperative outcomes between groups.


RESULTS
Patient age ranged from 17 to 74 years (mean, 42.6 years). Procedures included augmentation cystoplasty with or without creation of catheterizable stoma (31), ileovesicostomy (13), and ileal conduit (9). Mean age or mean operative time did not differ between the NGT(+) and NGT(-) groups. The NGT(-) patients experienced less time to oral intake (3.1 versus 4.4 days, P <0.01), fewer days to flatus (2.9 versus 4.0 days, P = 0.01), and fewer days to first bowel movement (4.4 versus 5.9 days, P = 0.01). We found no statistical differences in the incidence of postoperative complications. Overall hospital days were less in the NGT(-) patients, but this did not reach statistical significance (9.9 versus 11.0, P = 0.2).


CONCLUSIONS
Routine use of NGTs in patients undergoing bladder reconstruction or replacement for neurogenic bladder dysfunction seems to confer no benefit. The omission of NGTs in this population is possible without increasing overall morbidity. These findings parallel those previously reported in neurologically intact patients undergoing urinary diversion.
Erickson
Bradley A
BA
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. b-erickson@md.northwestern.edu
Dorin
Ryan P
RP
Clemens
J Quentin
JQ
D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods