Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population.

AIMS: To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction. METHODS: Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability. RESULTS: Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up. CONCLUSION: In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.

RCT of urethral versus suprapubic catheterization.

OBJECTIVE: To compare the use of intermittent urethral catheterization with indwelling suprapubic catheterization in women undergoing surgery for urodynamic stress incontinence or uterovaginal prolapse. DESIGN: Randomized controlled trial. SETTING: Tertiary referral urogynaecology unit. POPULATION: Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence. METHODS: Women were randomized into one of two groups. Group 1 had bladder drainage using a suprapubic catheter inserted in theatre. The catheter was left on free drainage for 48 hours post-operatively before clamping. Group 2 was catheterized intermittently post-operatively. MAIN OUTCOME MEASURES: Length of post-operative hospital stay: time to resume normal voiding (defined as voided volumes greater than 200 mls and residual urine volumes less than 100 mls on three occasions); number of urinary tract infections (UTIs); catheterization costs; patient experience (determined from questionnaire); and a pain score. RESULTS: 75 women were randomized; 38 to suprapubic catheterization; 37 to intermittent catheterization. Three were withdrawn from study, leaving 36 women in each group. Groups were closely matched for age and type of surgery undertaken. Length of hospital stay and total duration of catheterization were both significantly shorter for the intermittent catheterization group; although there was no difference in the rate of UTI between the two groups. There was no clear patient preference for a specific catheterization method. CONCLUSIONS: The use of intermittent catheterization following urogynaecological surgery is associated with a more rapid return to normal micturition and a shorter hospital stay, although the clinical significance of the difference is perhaps limited.

Outcomes of urinary diversion in children with spinal cord injuries.

PURPOSE: To gain a better understanding of the outcomes of the Mitrofanoff procedure for urinary diversion in children with spinal cord injury (SCI). DESIGN: Descriptive retrospective. PARTICIPANTS/METHODS: Individuals 6 to 27 years of age with SCI with at least 1 year follow-up after the Mitrofanoff procedure. Objective data collected via retrospective chart review include general demographics and medical/surgical history. Data collected via structured telephone interview include history of adverse urological events, bladder management, bladder management independence scores, patient satisfaction, and quality of life. RESULTS: Sixteen subjects (13 female, 3 male) with a mean age of 19 years (range 6-27 y) who underwent the Mitrofanoff procedure were interviewed. Length of postoperative follow-up ranged from 1 to 8 years (mean 4.25 y). Complications included stomal stenosis 25% (n=4) with a mean of 19 months to first occurrence of stenosis; urethral incontinence 75% (n=12); renal/bladder calculi 19% (n = 3); and stomal leakage 44% (n=7). Independence scores for bladder management after the Mitrofanoff procedure improved in 84% of subjects with tetraplegia and 25% of subjects with paraplegia. Eighty-eight percent (n 14) were satisfied with the procedure, while 12% (n=2) were somewhat satisfied. A thematic analysis of quality of life revealed that freedom (35%) and independence (35%) were most commonly cited. CONCLUSION: While some subjects experienced complications, satisfaction was relatively high and level of independence in bladder management was greatly improved. This study demonstrates that the Mitrofanoff procedure is a beneficial option to improve independence and ease of bladder management in children with SCI.

Outcomes and quality of life of adults undergoing continent catheterizable vesicostomy for neurogenic bladder.

OBJECTIVES: To evaluate the functional outcomes and quality of life of adult patients with neurogenic bladders who had undergone Casale Spiral Monti vesicostomy. METHODS: Twelve patients who underwent Casale Spiral Monti vesicostomy from May 1999 to December 2004 were evaluated with the Medical Outcomes Study 36-item short-form health survey to assess for postoperative quality of life. Complications and patient reported continence were also documented. RESULTS: The 12 patients (mean age 27.4 years) were followed up for a mean of 2.8 years. All 12 reported excellent urinary continence after the procedure, with only 7 patients who had the capacity to self-catheterize. Two patients reported wearing one light pad per day over the stoma. Two patients required one endoscopic dilation each for stomal stenosis, and one patient was readmitted 3 weeks postoperatively for the management of paralytic ileus. Eight patients reported no urinary tract infection since the operation. All 12 patients reported being very satisfied with the procedure. CONCLUSIONS: The results of this study have demonstrated that Casale Spiral Monti vesicostomy can have dramatic positive effects on the quality of life in adults with a neurogenic bladder by granting them social independence, convenient bladder management, and excellent continence rates.

Catheterization options following radical surgery for cervical cancer.

This trial assessed the potential benefits of intermittent self-catheterization (ISC) over standard care with suprapubic catheterization (SPC) in the postoperative bladder care of women with early-stage cervical cancer following radical hysterectomy. A prospective randomized controlled trial of 40 women was carried out. The urinary infection rate (catheter specimen of urine) was significantly higher in the ISC group at day 3 and day 5 (42% and 63%) compared to the SPC group (6% and 18%), p=0.05 and p=0.004, respectively. Forty-seven percent of patients randomized to SPC documented having problems arising from the SPC site, of which 23% were shown to have a positive wound swab. Despite a greater urinary tract infection rate, the technique of ISC was seen by women to be more acceptable, allowing fewer disturbances at night, greater freedom to live a normal life and less anxiety/embarrassment compared to SPC.

Continent urinary diversion: 10-year experience of Shriners Hospitals for Children in Chicago.

PURPOSE: To review long-term functional results, complications, and patient satisfaction in patients with a continent catheterizable urinary diversion. MATERIALS AND METHODS: A retrospective chart review and telephone satisfaction interviews were conducted. Bladder dysfunction was attributed to neurogenic bladder (n = 48: 23 spinal cord injury, 18 myelomeningocele, 4 sacral agenesis, 3 cerebral palsy), bladder exstrophy (n = 2), posterior urethral valves (n = 1), and other (n = 3). Patients underwent continent urinary diversion with either the Mitrofanoff principle (appendicovesicostomy, n = 47) or a Monti tube (ileovesicostomy, n = 8). Outcomes were assessed by chart review. Patient satisfaction was assessed by telephone interview and scored from 1 to 10 on a Likert-type scale. RESULTS: Between 1992 and 2003, 54 continent urinary diversions were performed on 17 boys and 37 girls. Mean age was 15.3 years (range, 7-21 years). An umbilical stoma was created in all patients. Seventy-three percent (40/54) and 47% (26/54) underwent concomitant bladder augmentation and urethral sling procedure, respectively. Mean follow-up was 2.5 years (range, 3 months to 10 years). Ninety-five percent (51/54) of patients were continent, and 5% (3/54) were incontinent from the umbilical stoma after one operation. All were compliant with intermittent catheterization. Complications included bladder calculi (15%; 8/54), stomal stenosis (9%; 5/54), stomal bleeding (5%; 3/54), small bowel obstruction (2%; 1/54), and superficial wound dehiscence (2%; 1/54). Seventy-three percent (40/54) of patients were available for telephone interview. Of these, 90% (36/40) reported satisfaction, and 10% (4/40) reported dissatisfaction; 93% (37/40) reported that they would recommend the procedure to others, whereas 7% (3/40) would not. CONCLUSION: In our series, continent urinary diversion with the Mitrofanoff principle or Monti tube is associated with high continence, compliance, and satisfaction rates and a low complication rate. An umbilical stoma was achievable in all patients. Our 10-year experience is consistent with other reported series and underscores the successful long-term outcome and durability of continent urinary diversions.

A sexualidade do ostomizado na visäo do parceiro: parte II / The ostomate's sexuality from his partner's view: part II

A condiçäo de ostomizado implica em mudanças no seu estilo de vida, daí a importância do processo reabilitatório ser implementado já na fase diagnóstica, visando o paciente como centro desse processo e como agente participante, incluindo neste contexto sua família, principalmente seu parceiro. O presente trabalho objetiva verificar o significado da sexualidade para o parceiro do ostomizado e verificar as mudanças e suas causas ocorridas na sexualidade do ostomizado, após a operaçäo de ostomia, na visäo do parceiro. Foram entrevistados 43 parceiros de portadores de estomas urinários e intestinais, sendo 21 mulheres e 22 homens, com idade média de 56 anos. Os resultados com relaçäo ao significado de sexualidade mostram igual porcentagem para as categorias relaçäo afetiva e ato sexual, correspondendo a 68,8 por cento das 61 respostas obtidas (34,4 por cento para cada uma); 70,5 por cento das 34 respostas para as mudanças ocorridas referem-se à ausência e diminuiçäo de relacionamento sexual e 62,1 das 37 respostas para as causas dessas mudanças relacionam-se às condiçöes psicológicas. Assim, podemos considerar que o parceiro do ostomizado pode estar hipertrofiando a afetividade para suprir a ausência de relacionamento sexual, constituindo um mecanismo compensatório para os distúrbios de auto-imagem e imagem corporal que afetam a sexualidade do ostomizado