https://doi.org/10.4081/aiua.2022.4.384

Outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction

Vol. 94 No. 4 (2022)
Submitted: November 12, 2022
Accepted: November 25, 2022
Published: December 27, 2022
Continent Urinary Diversion (CUD), Incontinent Urinary Diversion (IUD), Neurogenic bladder (NGB), Non-neurogenic bladder (non-NGB), lower urinary tract dysfunction (LUTD)
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Authors

Mostafa M. Mostafa
mostafaabdelaziz91@gmail.com
https://orcid.org/0000-0002-8750-6236
Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Asiut University Hospitals, Asiut, Egypt.
Ashraf Khallaf
Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Mohamed Kamel
Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Nilesh Patil
Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Ayman Mahdy
Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.

Objective: To evaluate the early and late outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction (LUTD).
Materials and methods: The charts of patients with refractory non-malignant LUTD who underwent continent or incontinent external urinary diversion at University of Cincinnati hospitals in the period between March 2012 and December 2019 were retrospectively reviewed. The demographic and baseline characteristics, surgery indications, operative data, early and late outcomes were collected, analyzed, and compared.
Results: A total of 78 patients including 55 patients with neurogenic bladder (NGB) and 23 patients with non-neurogenic bladder (non-NGB) refractory non-malignant LUTD were included. Fifty-three patients underwent incontinent urinary diversions (IUD), while 25 patients underwent continent urinary diversions (CUD). During the first 4 postoperative weeks, 53.85% (n=42) of patients developed complications, and the incidence was nonsignificantly higher in patients with NGB than those with non- NGB (56.36% vs 47.83%, p-value=0.490). Fever was exclusively encountered in patients with NGB earlier, while stomal retraction occurred only in patients with non-NGB later. More non- NGB patients had early wound infection. There was an overall improvement of urological symptoms in 52 patients (66.67%), and the rate was non-significantly higher in non-NGB patients than NGB patients (78.26% vs 61.82%, p-value=0.160). Late complications were reported in 47 patients and were more encountered in those with non-NGB than those with NGB (65.22% vs 58.18%). Stomal leakage and stenosis occurred more with CUD than with IUD (52% vs 0% and 28% vs 3.77%, respectively).
Conclusions: External urinary diversion can achieve a reasonable level of urological symptoms control in patients with refractory non-malignant LUTD, but with associated adverse outcomes. Although non-significantly, these complications tend to be higher in patients with IUD and/or NGB during the early postoperative period and higher with CUD and/or non-NGB on the long-term.

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Scopus
Google Scholar
Europe PMC
. Pozza G, Iafrate M, Mancini M, Silvestre C, Neri F, Furian L, et al. Outcome and quality of life of patients with augmented bladder or urinary diversion after kidney transplantation. Arch Ital Urol Androl. 2020;92(4). DOI: https://doi.org/10.4081/aiua.2020.4.286
Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19(10 Suppl):s191-6.
Shingleton WB, Bodner DR. The development of urologic complications in relationship to bladder pressure in spinal cord injured patients. J Am Paraplegia Soc. 1993;16(1):14-7. DOI: https://doi.org/10.1080/01952307.1993.11735878
Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol. 2015;7:85-99. DOI: https://doi.org/10.2147/RRU.S29644
Thuroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ, et al. [EAU Guidelines on Urinary Incontinence]. Actas Urol Esp. 2011;35(7):373-88. DOI: https://doi.org/10.1016/j.acuroe.2011.03.002
Brown ET, Osborn D, Mock S, Ni S, Graves AJ, Milam L, et al. Temporal Trends in Conduit Urinary Diversion With Concomitant Cystectomy for Benign Indications: A Population-based Analysis. Urology. 2016;98:70-4. DOI: https://doi.org/10.1016/j.urology.2016.06.035
Cohn JA, Large MC, Richards KA, Steinberg GD, Bales GT. Cystectomy and urinary diversion as management of treatment-refractory benign disease: the impact of preoperative urological conditions on perioperative outcomes. Int J Urol. 2014;21(4):382-6. DOI: https://doi.org/10.1111/iju.12284
Stein R, Schroder A, Thuroff JW. Bladder augmentation and urinary diversion in patients with neurogenic bladder: surgical considerations. J Pediatr Urol. 2012;8(2):153-61. DOI: https://doi.org/10.1016/j.jpurol.2011.11.014
Shreck E, Gioia K, Lucioni A. Indications for Augmentation Cystoplasty in the Era of OnabotulinumtoxinA. Curr Urol Rep. 2016;17(4):27. DOI: https://doi.org/10.1007/s11934-016-0585-3
Cicala C. [Classifications of urinary diversions]. Urologia. 2012;79 Suppl 19:20-3. DOI: https://doi.org/10.5301/RU.2012.9741
Davis I. Urinary Diversions: Reviewing the most common types of diversion. Can Fam Physician. 1991;37:1485-90.
Cody JD, Nabi G, Dublin N, McClinton S, Neal DE, Pickard R, et al. Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy. Cochrane Database Syst Rev. 2012(2):CD003306. DOI: https://doi.org/10.1002/14651858.CD003306.pub2
Stein R, Hohenfellner M, Pahernik S, Roth S, Thuroff JW, Rubben H. Urinary diversion--approaches and consequences. Dtsch Arztebl Int. 2012;109(38):617-22. DOI: https://doi.org/10.3238/arztebl.2012.0617
Brown ET, Osborn D, Mock S, Ni S, Graves AJ, Milam L, et al. Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population-based analysis. Neurourol Urodyn. 2017;36(5):1411-6. DOI: https://doi.org/10.1002/nau.23135
Jeong SJ, Oh SJ. The Current Positioning of Augmentation Enterocystoplasty in the Treatment for Neurogenic Bladder. Int Neurourol J. 2020;24(3):200-10. DOI: https://doi.org/10.5213/inj.2040120.060
Borghi C, Manservigi M, Milandri ES, Ippolito C, Greco P, Dell'Atti L. The impact of orthotopic reconstruction on female sexuality and quality of life after radical cystectomy for non-malignant bladder conditions. Arch Ital Urol Androl. 2021;93(3):255-61. DOI: https://doi.org/10.4081/aiua.2021.3.255
Amini E, Djaladat H. Long-term complications of urinary diversion. Curr Opin Urol. 2015;25(6):570-7. DOI: https://doi.org/10.1097/MOU.0000000000000222
Osborn DJ, Dmochowski RR, Kaufman MR, Milam DF, Mock S, Reynolds WS. Cystectomy with urinary diversion for benign disease: indications and outcomes. Urology. 2014;83(6):1433-7. DOI: https://doi.org/10.1016/j.urology.2014.02.030
Schiavina R, Borghesi M, Guidi M, Vagnoni V, Zukerman Z, Pultrone C, et al. Perioperative complications and mortality after radical cystectomy when using a standardized reporting methodology. Clin Genitourin Cancer. 2013;11(2):189-97. DOI: https://doi.org/10.1016/j.clgc.2012.12.003
Andersen AV, Granlund P, Schultz A, Talseth T, Hedlund H, Frich L. Long-term experience with surgical treatment of selected patients with bladder pain syndrome/interstitial cystitis. Scand J Urol Nephrol. 2012;46(4):284-9. DOI: https://doi.org/10.3109/00365599.2012.669789
Al Hussein Al Awamlh B, Lee DJ, Nguyen DP, Green DA, Shariat SF, Scherr DS. Assessment of the quality-of-life and functional outcomes in patients undergoing cystectomy and urinary diversion for the management of radiation-induced refractory benign disease. Urology. 2015;85(2):394-400. DOI: https://doi.org/10.1016/j.urology.2014.08.047
Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, et al. Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients. Cancer. 2005;104(1):36-43. DOI: https://doi.org/10.1002/cncr.21126
Boyd SD, Feinberg SM, Skinner DG, Lieskovsky G, Baron D, Richardson J. Quality of life survey of urinary diversion patients: comparison of ileal conduits versus continent Kock ileal reservoirs. J Urol. 1987;138(6):1386-9. DOI: https://doi.org/10.1016/S0022-5347(17)43649-4

How to Cite

Mostafa, M. M., Khallaf, A., Kamel, M., Patil, N., & Mahdy, A. (2022). Outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction. Archivio Italiano Di Urologia E Andrologia, 94(4), 384–389. https://doi.org/10.4081/aiua.2022.4.384
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