RESUMO
OBJECTIVES: To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway. MATERIALS AND METHODS: All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year. RESULTS: One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%. CONCLUSION: A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care.
Assuntos
Cirurgia Plástica , Bexiga Urinaria Neurogênica , Humanos , Bexiga Urinaria Neurogênica/cirurgia , Estudos Retrospectivos , Procedimentos Clínicos , Estudos de Viabilidade , Bexiga UrináriaRESUMO
INTRODUCTION: To specifically introduce continent cystostomy - indications, surgical technique, complications and management - to the nurses working in a urology department. METHOD: The present article is based on a review of the literature and author's experience in continent cystostomy. RESULTS: Continent cystostomy is a neo-conduit placed between the bladder and the anterior abdominal wall using the digestive tract. It is usually performed in patients with bladder voiding dysfunction who cannot undergo clean self-intermittent catheterization through the urethra. The high success rate (>84%) associated with this procedure should not hide the frequent associated complications with the conduit. CONCLUSION: Even if continent cystostomy is associated with good mid- and long-term functional outcomes, it requires a close follow-up and in some cases "adjustments".