title: Supratrigonal cystectomy with Hautmann pouch as treatment for neurogenic bladder in spinal cord injury patients: long-term functional results.
abstract: OBJECTIVE
  To study clinical and urodynamic data along with immediate and long-term morbidity of surgical management of neurogenic bladder in spinal cord injury (SCI) patients
  
  
  METHODS
  Single-center retrospective study of 61 SCI patients with neurogenic detrusor overactivity (NDO) related urinary incontinence and/or sphincter weakness incontinence who underwent supratrigonal cystectomy with Hautmann pouch ± concomitant stress incontinence procedure (27.9%; n = 17).
  
  
  RESULTS
  With a mean follow-up of 5.84 years (range 1-20.5) an improved or total continence rate was achieved in 89.7% and 74.1%, respectively. Surgery failed (incontinence persisted) for six (10.3%) patients, three of which had a simultaneous procedure for stress incontinence. On urodynamics, maximum cystometric capacity (MCC) (ml) increased from 305.2 to 509.4 (P < 0.05), mean compliance (ml/cmH(2) O) increased from 15 to 42.7 (P < 0.05) and mean detrusor pressure at MCC (cmH(2) O) fell from 54.1 to 19.1 (P < 0.05). Persisent NDO occurred in 20.7% compared to 59% pre-operatively (P < 0.05). The overall complication rate was 37.7% but ≤Clavien grade 2 in 82.6%. Notably, the incidence of bowel dysfunction, namely diarrhea and/or fecal incontinence was 27.5%. Concomitant outlet surgery was associated with increased morbidity as three (17.6%) complications led to re-intervention.
  
  
  CONCLUSIONS
  Supratrigonal cystectomy with Hautmann pouch is an excellent surgical treatment for SCI patients suffering from refractory NDO incontinence. It achieves the main goals of achieving continence (74% complete), reducing rates of infection and preserving upper tract function, which is reflected in the improvement on urodynamics. The incidence of secondary bowel dysfunction and potential risk of a simultaneous procedure for stress incontinence needs to be discussed.
authors.affiliation: Department of Urology, Groupe Hospitalier Pitié-Salpétrière, Paris, AP-HP, Medical School Pierre et Marie Curie, Paris VI University, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gobeaux
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.forename: Alexia
authors.initials: A
authors.lastname: Even-Schneider
authors.forename: Francois
authors.initials: F
authors.lastname: Richard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D003967:Diarrhea / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005602:France; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D019738:Surgically-Created Structures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053201:Urinary Bladder, Overactive / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics; D055815:Young Adult
chemical_list: D018680:Cholinergic Antagonists