Page 138 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

136
Chapter 7
pletely dry/some leakage, 1 pad is enough/ leakage with need for a stomal bag/stoma is completely incontinent/catheter in stoma), 3) urethral leakage (did you have any urethral incontinence the last two weeks? Yes/no), 4) difficulty with catheterization (always easy/ most of the time easy, sometimes not easy or painful/ always problematic or painfull), and 5) willingness to recommend this procedure to others with a comparable condition.
Demographic data extracted included patients’ sex, age, body mass index (BMI) at time of surgery, length of hospital stay, underlying disease and the indication for a CCUC. Num- ber of reoperations and the occurrence of complications served as outcome measures.
Stenosis was sub-divided in to cutaneous/fascial stenosis (superficial stenosis) and stenosis at conduit-bladder level (deep stenosis), stenosis was considered as a complica- tion if a dilatation or a reoperation was needed, and the stenosis could not be resolved by minimally invasive therapies like ACE-stoppers or night-time catheters. Stomal or urethral urinary incontinence (UI) was considered a complication if reoperation was considered or patient could not properly absorb the leakage with incontinence material. Stomal pain during CIC was considered a complication if the patient had visited the emergency room or the outpatient clinic because of problems with CIC caused by pain or had been hos- pitalized for this reason. Urosepsis was considered as a complication when the patient was hospitalized for this reason. Stoma related reoperations were either stoma revisions (superficially), conduit revisions ( including re-implantation of the conduit into the blad- der), channel replacement (Mitrofanoff-channel to monti-channel, or monti-channel to a new monti channel), closing of the channel, using bulking agent at stoma level or augmentations. The use of a bulking agent in the urethra and dilatation of the stoma under general anesthesia were also registered but not as a stoma related reoperation.
Statistical analyses were performed with the statistical package SPSS statistics 24. Non- normally distributed variables are presented as median (interquartile range). Tests for normality were performed using the Shapiro-Wilk test. Non-parametric and Chi-square tests were performed to analyze risk factors (age and BMI) for reoperation. A P-value of < 0.05 was considered as statistically significant.
RESULTS
Table 1 shows patient demographics and diagnoses. The median follow-up was 52 months, with an interquartile range (IQR) from 19 to 120 months. The underlying diagnosis was neurogenic bladder in 26 patients (63%) and non-neurogenic bladder in 15 patients (37%). Concomitant surgery was performed in 24 patients; ileocystoplasty was the most common performed concomitant surgery (n=16). Bladder outlet procedures like bladder neck surgery or a bladder neck sling were performed in 6 patients. Two patients received onabotulinumtoxinA injections per-operatively. The stoma was placed umbilically in 35 (85%) cases. In 6 (15%) cases the stoma was placed in the right lower abdomen