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Urinary incontinence after continent urinary diversion using cecal wrap or plicated ileum: a patient questionnaire
Aseem R Shukla1, Julio M Pow-Sang, Mohammed A Helal
1Division of Urology, Department of Surgery, University of South Florida Health Sciences Center and H. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA.
Objectives:
To evaluate the clinical and urodynamic results of a tapered-cecal wrap (TCW) versus a tapered-plicated ileal (TPI) anti-incontinence mechanism.
Methods:
Of 54 consecutive patients who had undergone continent urinary diversions, 33 (17 with TCW and 16 with TPI) were evaluated. The primary disease that prompted diversion included bladder cancer (84%), neurogenic bladder (12%), and interstitial cystitis (3%). All patients were evaluated using a telephone questionnaire regarding ease of catheterization, degree of continence, occurrence of postoperative complications, and overall satisfaction in relation to their stoma. In addition, 6 patients in the TPI group and 5 in the TCW group underwent enterocystometry and outlet pressure recording. The mean follow-up was 30 months for the TCW group and 48 months for the TPI group.
Results:
The overall functional continence rate was 100% for the TCW group and 81.3% for the TPI group. Transient difficulty with catheterization occurred in 35.3% of the TCW group and 18.7% of the TPI group. No differences were observed in the occurrence of postoperative complications. Urodynamics demonstrated a statistically significant increase in maximal outlet pressure with the reservoir full in the TCW group that was not noted in the TPI group.
Conclusions:
The addition of a cecal wrap to the efferent limb results in significantly improved continence. This was supported urodynamically with demonstration of an increase in maximal outlet pressure with the reservoir full in the TCW group. No difference in the surgical complication rate or long-term difficulty with catheterization was observed.