title: Continent catheterizable tubes/stomas in adult neuro-urological patients: A systematic review.
abstract: OBJECTIVE
  To systematically review all available evidence on the effectiveness and complications of continent cutaneous stoma or tube (CCS/T) to treat bladder-emptying difficulties in adult neuro-urological patients.
  
  
  METHODS
  The search strategy and studies selection were performed on Medline, Embase, and Cochrane using the PICOS method according to the PRISMA statement (CRD42015019212; http://www.crd.york.ac.uk/PROSPERO).
  
  
  RESULTS
  After screening 3,634 abstracts, 11 studies (all retrospective, enrolling 213 patients) were included in a narrative synthesis. Mean follow-up ranged from 21.6 months to 8.7 years (median: 36 months, IQR 28.5-44). At last follow-up, the ability to catheterize rate was ≥84% (except in one study: 58.3%) and the continence rate at stoma was >75%. Data comparing health-related quality-of-life before and after surgery were not available in any study. Overall, 85/213 postoperative events required reoperation: 7 events (7 patients) occurring ≤3 months postoperatively, 22 events (16 patients) >3 months, and 56 events (55 patients) for which the time after surgery was not specified. Sixty additional complications (60 patients) were reported but did not require surgical treatment. Tube stenosis occurred in 4-32% of the cases (median: 14%, IQR 9-24). Complications related to concomitant procedures (augmentation cystoplasty, pouch) included neovesicocutaneous fistulae, bladder stones, and bladder perforations. Risk of bias and confounding was high in all studies.
  
  
  CONCLUSIONS
  CCS/T appears to be an effective treatment option in adult neuro-urological patients unable to perform intermittent self-catheterization through the urethra. However, the complication rate is meaningful and the quality of evidence is low, especially in terms of long-term outcomes including the impact on the quality-of-life.
authors.affiliation: Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
authors.affiliation: Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Boissier
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bertil F M
authors.initials: BFM
authors.lastname: Blok
authors.affiliation: Department of Neuro-Urology, Careggi University Hospital, Florence, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Del Popolo
authors.affiliation: Department of Neuro-Urology, Careggi University Hospital, Florence, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Musco
authors.affiliation: Department of Urology, Hospital Universitario de Canario, Universidad de La Laguna, Tenerife, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Castro-Diaz
authors.affiliation: Department of Urology, Hospital Universitario de Canario, Universidad de La Laguna, Tenerife, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Padilla Fernández
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Groen
authors.affiliation: Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: 't Hoen
authors.affiliation: Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom.
authors.forename: Hazel
authors.initials: H
authors.lastname: Ecclestone
authors.affiliation: Department of Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.affiliation: Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gross
authors.affiliation: Department of Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.|Brain Research Institute, University of Zürich, Zürich, Switzerland.|Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Schneider
authors.affiliation: Department of Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
authors.affiliation: Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
mesh_terms: D006801:Humans; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014546:Urinary Catheterization; D016476:Urinary Reservoirs, Continent
keywords: continence; diversion; intermittent catheterization; neurogenic bladder; reconstruction