Outcomes of continent catheterizable stomas for urinary and fecal incontinence: comparison among different tissue options
ABSTRACT To retrospectively review the outcome of appendix, transverse tubularized intestine segments, caecal flap, gastric tube and others tissue options used as a continent stoma for urinary and fecal incontinence.
Between January 1993 and January 2003 we created 179 continent stomas to treat urinary and fecal incontinence in 135 patients (81 females and 54 males; mean age at surgery 13 years, 118, 87%, aged <17 years). We used either appendix (112), a short segment of bowel following the Yang-Monti technique (49), gastric augment single pedicle tube (eight), caecal flap (seven), Casale continent vesicostomy (two) and Meckel's diverticulum (one). Thirty-six patients had both urinary and fecal continent stomas created.
The mean follow-up for the appendix group was 46 months for the urinary stoma and 23 months for the Malone antegrade continent enema (MACE) stoma. Stoma-related complications occurred in 24 of 112 (21%) patients; there was complete channel fibrosis in five (4%). The mean follow-up for the Yang-Monti group was 38 months for the urinary and 59.2 months for the MACE stoma. There were stoma-related problems in 11 of 49 (22%) patients, with complete channel fibrosis in three (6%). Overall, in the long-term follow-up, there were stoma-related complications in 42 of 179 (23.5%) procedures.
Continent catheterizable stomas are a feasible and reliable method for treating urinary and fecal incontinence. Long-term success can be accomplished with appendix, transverse tubularized intestinal segments and caecal flaps, with similar complication rates in all groups. Surgeon preference and individual patient status should determine the surgical technique to be used.
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ABSTRACT: The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches.Gastroenterology clinics of North America 12/2013; 42(4):815-36. DOI:10.1016/j.gtc.2013.09.006 · 1.92 Impact Factor
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ABSTRACT: Aims To evaluate the feasibility, the efficiency, the results of continent cystostomy in adult population. Material and methods Retrospective study of patients who underwent a continent cystostomy between 1987 and 2011. Results Forty-three patients underwent a continent cystostomy (13 men and 30 women). The mean age at surgery was 53.4 ± 14.6 years. The mean BMI was 25 kg/m2. No death in relation with the cystostomy was reported. Thirty-two patients had a neurological pathology (74.4%), 11 a pathology other than neurological (25.6%). A retention bladder was reported for 12 patients (27.9%), 17 (39.5%) were incontinent, and 14 (32.6%) had a mixed symptomatology. All patients had urodynamics and an evaluation of the urinary tract. Nineteen appendicovesicostomy were made, 15 double Monti-procedure, six simple Monti-procedure, three channels were made of an association of ileon and appendix. Seventeen patients underwent an augmentation cystoplasty in combination with the continent catheterizable conduit. The mean follow-up was 47.6 ± 29 months. Continence was achieved in 37 patients (86%), two patients underwent a Bricker. Stomal stenosis occurred in eight patients (18.6%), with a median time of 16.1 ± 20.4 months. Leakage occurred after bladder neck closure for two patients (4.6%). Clean intermittent catheterization were performed by 30 patients, catheterization by a care giver for four patients, seven did not use their stomy because of the evolution of their causal pathology, or because of an intercurrent pathology. No difference between the channels (Mitrofanoff versus Monti) was reported. Conclusion Continent catherizable cystostomy were a feasible method of continent urinary diversion in an adult population. This study demonstrated their feasibility in an adult population and their long-term efficiency with a mean follow-up of 47.6 months and 127 months for one of them. With a rate of continence upper than 80%, it was an effective technique of urinary diversion associated with intermittent catheterization.Progrès en Urologie 06/2012; 22(7):415–423. DOI:10.1016/j.purol.2012.02.003 · 0.77 Impact Factor
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ABSTRACT: To describe our technique and long-term results with creation of a continent urinary channel in adults with neurogenic bladder (NGB) using a single piece of bowel. From 2004 to 2013, 26 adult patients underwent creation of a continent urinary channel by a single surgeon. A retrospective medical record review was performed noting the indications, technique, concomitant procedures, complications, and outcomes. Continence outcome, ease of catheterization, and need for further surgical interventions are reported. Twenty women and 6 men were identified with a mean age of 48 years (range, 25-80) and a follow-up of 64 months (range, 22-100). The mean body mass index (BMI) was 30.5 kg/m(2) (range, 20.1-50.2). All patients had benign bladder disease, including 22 (85%) with known neurologic disease and 4 with a devastated bladder outlet. Creation of a continent urinary channel was performed using the single Monti tube in 1, double Monti tube in 7, and the Casale (Spiral Monti) in 18. Mean hospital stay was 10.5 days (range, 5-37). The most common complication was recurrent urinary tract infection that occurred in 14 patients (54%). There were 5 (19%) bowel complications and 1 (4%) bladder perforation. The percentage of patients continuing to catheterize via the stoma with a BMI of <30 kg/m(2), between 30 and 40 kg/m(2) and >40 kg/m(2) was 89%, 50%, and 25%, respectively. The Monti and Casale procedures are effective in creating a long continent urinary channel for catheterization in the adult population with neurogenic bladder, regardless of BMI. However, despite an intact channel, stomal self-catheterization appears to be challenging in morbidly obese patients.Urology 03/2014; DOI:10.1016/j.urology.2013.12.046 · 2.13 Impact Factor