Page 144 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf
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Chapter 7
making is only possible when the patient is aware of the possible complications and the probability of reoperation.
The applicability of a CCUC in adult patients with lower urinary tract dysfunction re- mains questionable. An important consideration is the lack of other options when qual- ity of life is affected by painful CIC, difficulty in performing CIC, urinary tract infections or problems with indwelling catheters. An alternative might be an incontinent urinary diversion (Ileum conduit), but this type of surgery is more invasive and also known for its complications. Most patients would prefer a continent stoma.12
Table 5. Overview of the published literature.
 Patients Author Year N/NN
Current study 2019 26/15
Perrouin-Verbe et al. 2016 29/0
Rey et al. 2013 11/4
Van der Aa et al. 2009 12/23
Sahadevan et al. 2008 7/22
Touma et al. 2007 12/0
Karsenty et al. 2007 12/0
Follow-up
52 M (19–120)
66 M (50-80)
22 M ( 9-33)
62 M (6–117)
10.5 Y (0.4–16)
2.8 Y (0.25–5.8)
44 M (20–56)
Age
32 Y
35 Y
32 Y
44 Y
48 Y
(23–49)
(26-46)
(22–65)
(21–80)
(18–79)
Re- Continence Stenosis operation
88% 46% 49%
100% 6% 24%
- - 20%
75% 29% 54%
89% 57% 49%
- - -
100% - 0%
      27 (14–50)
42 Y (18–63)
  N = neurogenic bladder, NN = non-neurogenic bladder, M = months, Y = year.
The reoperation rate of 48.8% we found falls within the range reported in the sparse literature (detailed in table 5).10,13-17 Studies on predicting factors for complications have shown contradictory results. In a study by De Ganck et al. in 53 patients (mean age 19 years, SD 13), multiple regression analysis showed no association between the complica- tion/follow-up ratio and age.15 In contrast, Sahadevan and colleagues described a sig- nificantly increased incidence of stomal complications in 29 patients aged > 50 years.14 A recurrent point of discussion is the heterogeneity of the studied populations, making a balanced comparison challenging.11 Together with low numbers of patients, statistical analysis to find predicting factors for complications or reoperation is difficult. We found a significantly increased risk on reoperations for patients above the age of 32 at the time of surgery. This finding should be interpreted with caution, as duration of follow- up may be a confounding factor. A high BMI has not yet been identified as significant risk factor for stomal complications in patients with a CCUC, which could be due to the small patient samples studied. However BMI is reported as risk factor for complications in many other types of stoma, for example colorectal stoma.18 Moreover, in patients with a myelomeningocele or other spinal cord diseases, the BMI might not be a good predictive parameter for the amount of abdominal fat, because BMI is not taking the underdeveloped muscles in the legs of these patients in to account. In essence, all this information could be helpful for the urologist and the patient to decide on constructing























































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