[Neurogenic bladder and continent cystostomy: Results of a monocentric cohort in a French university hospital]

Abstract

Objective: The main objective was to evaluate the complications of continuous urinary shunts in a French university hospital according to surgical technique and functional results especially on continence. The secondary objective was to evaluate the management of complications.

Methods: A retrospective study was conducted between January 2008 and August 2017. Patients who had a continent cystostomy with or without bladder augmentation were included. Diversions for non-neurological causes were excluded. Cystostomy was performed using the appendix or a Monti's artifice. Data collected included complications and their management, functionality of the diversion and of the bladder reservoir, cystostomy continence, and urethral continence.

Results: Nineteen patients were included. The median follow-up time was 46 months. The majority of early postoperative complications were classified as grade II Clavien-Dindo. No postoperative deaths occurred. Late complications most frequently involved cystostomy duct stenosis (n=5), cystostomy incontinence (n=5), and urethral incontinence (n=8). Thirteen patients had revision surgery for late complications. Late complications on continence evolved favorably after revision surgery or medical treatment in all, but one case.

Conclusion: Our results are consistent with the literature. Complications and the re-interventions are frequent and should lead to a multidisciplinary information and evaluation of the patient in preoperative care.

Level of proof: 3.

Keywords: Continent urinary diversion; Cystostomie; Cystostomy; Dérivation urinaire continente; Neurogenic bladder; Vessie neurologique.