title: The Impact of Transtomal Rigid Endoscopy in Continent Cutaneous Urinary Diversions.
abstract: OBJECTIVE
  To determine if transtomal rigid endoscopy damages the continence mechanism of continent cutaneous reservoirs. We report the largest and longest series to date from a single institution demonstrating the safety of transtomal rigid endoscopy.
  
  
  METHODS
  We conducted an institutional review board-approved retrospective review of a prospectively accrued database of all patients with urinary diversions that underwent rigid endoscopic procedures for various reasons between 2000 and 2013. Pre- and postoperative continence, difficulty with catheterization, and need for surgical revision post procedure were evaluated.
  
  
  RESULTS
  From 2000 to 2013, 71 patients with continent cutaneous diversions underwent 191 endoscopic procedures by a single surgeon. Mean follow-up was 603 days. Mean age was 58.4 years. The mean number of procedures per patient was 2.7 (1-7). All procedures were performed by gaining access through the stoma with an offset rigid nephroscope and a 28-30Fr access sheath. Two patients reported incontinence postoperatively; 1 patient was treated conservatively by way of indwelling catheter for 1 week and full continence returned. The second patient had small-volume incontinence preoperatively that worsened postoperatively. The procedure uncovered an existing efferent limb-cutaneous fistula. Patients undergoing repeated procedures were not at any higher risk of incontinence. There were no patients that had difficulty with catheterization postoperatively. No surgical revisions were required for worsened continence postoperatively.
  
  
  CONCLUSIONS
  Transtomal rigid endoscopic procedures do not negatively affect the continence mechanism in continent cutaneous diversions. Transtomal rigid endoscopy allows for safe endoscopic access in these difficult to treat patients.
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Charles
authors.initials: C
authors.lastname: Metcalfe
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Loh-Doyle
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Andre L
authors.initials: AL
authors.lastname: Abreu
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Raj
authors.initials: R
authors.lastname: Satkunasivam
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Raed
authors.initials: R
authors.lastname: Azhar
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Vannita
authors.initials: V
authors.lastname: Simma-Chiang
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA. Electronic address: mdunn@med.usc.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dunn
mesh_terms: D019723:Endoscopes; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000517:prevention & control*; D016476:Urinary Reservoirs, Continent; D014554:Urination