title: Long-term complications of continent cutaneous urinary diversion in adult spinal cord injured patients.
abstract: To report the long-term complications of continent cutaneous urinary diversion(CCUD) in spinal cord injured(SCI) patients unable to perform intermittent self-catheterization(ISC) through the urethra.
  
  
  
  Between July 2001 and January 2012, adult SCI patients with a neurogenic bladder who underwent CCUD according to Mitrofanoff's/Monti's/Casale's principle were enrolled. A concomitant supratrigonal and augmentation enterocystoplasty were performed because of refractory detrusor overactivity or low bladder compliance. Early postoperative complications were reported according to Clavien-Dindo classification. Long-term complications, stomal and urethral continence, renal function, urodynamic parameters and quality-of-life were assessed.
  
  
  
  Overall, 29 consecutive SCI patients were included, median age 35 years (IQR 26-46). Median follow-up time was 66 months (IQR 50-80). Two post-operative severe complications (grade III-IV) were reported. One patient had a stomal stenosis and another patient a tube stenosis. Both were treated by dilation. Two patients developed fistulae between the tube and the skin and required a surgical treatment. Three patients had bladder stones managed with endoscopy. Two patients had remnant stress urine leakage through the urethra, which was treated surgically: one received periurethral balloons(ACTTM) and one a tension-free vaginal tape. Creatinine clearance remained stable postoperatively. Urodynamic parameters were significantly improved. At last follow-up, 100% of patients had a catheterizable continent stoma and urethral continence was achieved in 96%. An improvement of quality-of-life was reported by 90% of patients.
  
  
  
  CCUD allowed these patients to keep ISC as a voiding pattern and to be continent without any appliance. The main complications were related to the tube and to bladder enlargement; thus, annual monitoring is required. Neurourol. Urodynam. 35:1046-1050, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France.
authors.forename: Marie-Aimée
authors.initials: MA
authors.lastname: Perrouin-Verbe
authors.affiliation: Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.affiliation: Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles Saint-Quentin en Yvelines University, France.
authors.forename: Alexia
authors.initials: A
authors.lastname: Even
authors.affiliation: Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles Saint-Quentin en Yvelines University, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.affiliation: Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France. phe.veronique@gmail.com.
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D011788:Quality of Life; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D053201:Urinary Bladder, Overactive / Q000601:surgery; D014546:Urinary Catheterization; D014547:Urinary Diversion / Q000009:adverse effects*; D014563:Urodynamics
keywords: continent cutaneous urinary diversion; intermittent catheterization; mitrofanoff; monti; neurogenic bladder; spinal cord injury