title: Prospective evaluation of laparoscopic assisted cystectomy and ileal conduit in advanced multiple sclerosis.
abstract: OBJECTIVE
  To assess the morbidity, mortality, and impact on quality of life and renal function after laparoscopic cystectomy and ileal conduit in patients with multiple sclerosis with lower urinary tract symptom refractory to conservative management.
  
  
  METHODS
  A prospective study was conducted between February 2004 and December 2010 on 44 consecutive patients with multiple sclerosis who underwent laparoscopic cystectomy and ileal conduit for lower urinary tract symptom. Median Expanded Disability Status Scale score was 8 (6.5-8.5). Mean duration of multiple sclerosis was 19.3 ± 7.9 years. The quality of life was determined using the validated Qualiveen questionnaire preoperatively and at minimum 6 months after the surgery.
  
  
  RESULTS
  No conversion to open surgery was required. Postoperative morbidity rate was 18.2%; minor (Clavien ≤ 2) and major (Clavien ≥ 3) complications occurred in 13.6% and 6.8%, respectively. Mean follow-up was 44.5 ± 20.6 months. Complications noted were asymptomatic ureteroileal stenosis (n = 6) and pyelonephritis (n = 3). Neurological status and Expanded Disability Status Scale score remained stable throughout. Renal function remained unchanged. Limitations, constraints, and specific urinary impact index subscores of the Qualiveen were significantly improved at 6 months time.
  
  
  CONCLUSIONS
  Laparoscopic cystectomy and ileal conduit for lower urinary tract symptom in advanced multiple sclerosis is a safe procedure with low complications. Neurological status and renal function remain stable and quality of life improves and continues to remain improved during long-term follow-up, suggesting this to be an attractive option in patients with advanced multiple sclerosis with lower urinary tract symptom refractory to conservative treatment.
authors.affiliation: Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Jalesh N
authors.initials: JN
authors.lastname: Panicker
authors.forename: Evelyne
authors.initials: E
authors.lastname: Castel-Lacanal
authors.forename: Frédérique
authors.initials: F
authors.lastname: Viala
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.forename: Bernard
authors.initials: B
authors.lastname: Malavaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Marque
authors.forename: Michel
authors.initials: M
authors.lastname: Clanet
authors.forename: Pascal
authors.initials: P
authors.lastname: Rischmann
authors.forename: Xavier
authors.initials: X
authors.lastname: Gamé
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000209:etiology; D015653:Cystectomy / Q000009:adverse effects; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology; D010535:Laparoscopy / Q000009:adverse effects; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D009460:Neurologic Examination; D011704:Pyelonephritis / Q000209:etiology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014513:Ureter / Q000473:pathology; D014547:Urinary Diversion / Q000009:adverse effects