Page 137 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf
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                 Long-term results of continent catheterizable urinary channels 135
INTRODUCTION
Many patients with neurogenic or non-neurogenic lower urinary tract dysfunction are dependent on either clean intermittent catheterization (CIC) or an indwelling catheter for bladder emptying. Despite good instructions and feasible equipment, both ap- proaches may give rise to problems such as urinary tract infection, pain and bleeding.1-3 CIC requires a good dexterity, which may be challenging for people with spinal cord injury, especially those patient that are wheelchair bound. If management with CIC or an indwelling catheter affects a patient’s quality of life too much, the alternative is to construct a continent catheterizable urinary channel (CCUC).4 Mitrofanoff appendi- covesicostomy and the Monti ileovesicostomy are the most often used catheterizable channels.5-7 These procedures have been used in children and adolescents for more than three decades. Recently, our group showed that an appendicovesicostomy is an effec- tive and durable solution for children when CIC is not feasible.8 Little is known about the feasibility and risk factors for complications of CCUCs in adults. Publications so far show a wide range of complication rates and most cohorts included only patients with a neurogenic bladder dysfunction.7,9-11
The aim of this study was to evaluate the long-term results of CCUCs applied in adults and to identify possible risk factors for complications.
MATERIALS AND METHODS
The medical charts of 41 consecutive adults who had received a CCUC were retrospec- tively reviewed. Surgeries had been performed by three different experienced urologists, between November 1998 and November 2016 at the Erasmus University Medical Center, Rotterdam and at the University Medical Center Groningen, Groningen. The procedures used were those described by Mitrofanoff or Monti.5,6 A Stoma was constructed either in the umbilicus with a V-shaped skin flap or in the right lower abdomen. A catheter was placed in the constructed stoma. Three to six weeks later the catheter was removed and the patient started with CIC. Follow-up was initially every 3 to 6 months, but the time interval was extended up to a year if bladder function remained stable and catheteriza- tion proceeded without problems.
After obtaining approval by the local ethics committee (MEC-2017-354), all patients who were still using the channel by the end of December 2017 were sent a 5-item questionnaire. The first question was the global impression of improvement (PGI-I instrument). 1) The PGI-I is a single question to rate the urinary tract condition now, as compared to before beginning treatment (construction of the CCUC) on a scale from 1: Very much better, to 7: Very much worse. The other questions were addressing 2) continence of the stoma (com-
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