Continent ileovesicostomy after bladder neck closure as salvage procedure for intractable incontinence.
BACKGROUND
We evaluated the success rate of continent vesicostomy using an ileal segment with seroserosally embedded, tapered ileum for bladder augmentation with continent stoma following bladder neck closure (BNC) for severely damaged bladders or persistent urinary incontinence.


METHODS
A total of 15 patients were treated for persistent urinary incontinence or non-reconstructible bladder outlet between 2003 and 2012. Underlying diagnosis included post-prostatectomy incontinence (n = 5), recurrent bladder neck stenosis (n = 5), neurogenic bladder (n = 3), urethral tumor recurrence following orthotopic neobladder (n = 1) and post-TVT and colposuspension incontinence (n = 1). All patients underwent open BNC, omental interposition and continent vesicoileostomy. The continent outlet was placed in the lower abdomen using a circumferential subcutaneous and skin plasty to avoid retraction. Data collected included age, underlying diagnosis, stoma site, time to complications and need for subsequent surgical revisions. All patients received a standardized questionnaire at the time of data acquisition and were personally interviewed.


RESULTS
Median follow-up was 24 months (range: 2-111). Primary BNC was successful in all patients and primary continence rate was 86.7%. Two patients (13.3%) suffered from failure of the continence mechanism, caused by stoma stenosis at skin level and insufficiency of the bladder augmentation and stoma due to local infection. One additional patient developed a mild stomal incontinence without need for further reconstruction. Regardless of the number of revisions, at the last follow-up 93.3% of patients had a functional channel. All complications occurred within the first postoperative year.


CONCLUSIONS
This technique is an effective last resort treatment for patients with non-reconstructible bladder outlet.
St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany ; The selected authors contributed equally to this work.
Jennifer
J
Kranz
St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany ; The selected authors contributed equally to this work.
Petra
P
Anheuser
Klinikum Fulda, Klinik für Urologie und Kinderurologie, Fulda, Germany.
Steffen
S
Rausch
Universitätsklinikum Bonn, Klinik und Poliklinik für Urologie und Kinderurologie, Bonn, Germany.
Guido
G
Fechner
Heilig Geist-Krankenhaus, Klinik für Urologie, Köln-Longerich, Germany.
Moritz
M
Braun
Universitätsklinikum Bonn, Klinik und Poliklinik für Urologie und Kinderurologie, Bonn, Germany.
Stefan C
SC
Müller
St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany.
Joachim A
JA
Steffens
Klinikum Fulda, Klinik für Urologie und Kinderurologie, Fulda, Germany.
Tilman
T
Kälble
catheterization; continent vesicostomy; incontinence; tapered ileum; urinary diversion