A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra.
METHODS
Description of a technique and prospective follow-up study.


OBJECTIVE
To present and assess a perioperative strategy associated with a single-procedure surgical technique for continent cutaneous diversion in spinal cord injury (SCI) patients requiring self-catheterization and unable to do it through the native urethra.


METHODS
University hospital, Paris, France.


METHODS
We considered SCI patients suffering from urinary incontinence related to neurogenic detrusor overactivity and/or poor bladder emptying for more than 1 year and inability to perform self-catheterization through the native urethra. These patients including quadriplegics underwent selection for surgery by occupational therapists and neurorehabs to assess the ability to self catheterize through an abdominal stoma and to determine the optimal site to place the stoma. The surgical technique included a single procedure: aponevrotic sling in women requiring stress continence reinforcement, supratrigonal cystectomy, preserved detrusor wall flap (original description), enterocystoplasty, a catheterizable tube using either the Mitrofanoff or Young-Monti principle and Politano-Leadbetter anti-reflux technique. A prospective follow-up study of consecutive patients reviewed initial condition, indication, surgical technique, complications, continence, catheterizing difficulties, functional bladder capacity and serum creatinine.


RESULTS
Thirteen consecutive patients were selected for surgery. Median follow-up was 44 months. Stoma location was variable from one patient to another. All patients had a catheterizable continent stoma at last follow-up. Kidney function was preserved.


CONCLUSIONS
Given these results, a multidisciplinary approach including neuro-rehabilitation practitioners and urologists performing appropriate technical solutions in highly selected SCI patients unable to catheterize native urethra provides upper urinary tract protection and continence after a single procedure.
Karsenty
G
G
Department of Urology, Pitié-Salpetrière Hospital, Pierre et Marie Curie School of Medicine Paris VI, Paris, France. gilles.karsenty@ap-hm.fr
Chartier-Kastler
E
E
Mozer
P
P
Even-Schneider
A
A
Denys
P
P
Richard
F
F
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*