SUFU 2018: Incontinent Ileovesicostomy for Neurogenic Bladder Dysfunction: Long Term Clinical and Urodynamic Patient Outcomes

Austin, TX (  Dr. Mihir Shah and colleagues evaluated the long term urodynamic outcomes changes in bladder management in a series of patients treated with ileovesicostomy for neurogenic bladder dysfunction.

This was a retrospective chart review of 19 men and 12 women with a mean age of 44.9 years who underwent incontinent ileovesicostomy at single institution between 1992 and 2002. Mean follow-up was 156 months (range 126-183 months). They compared detrusor leak point (DLPP) preoperatively and postoperatively and determined long-term urinary tract management.

There was 2 male patients underwent conversion of the incontinent ileovesicostomy to ileocystoplasty using the same segment of bowel and now manage their bladder by intermittent catheterization. These patients were excluded from analysis. Three female patients underwent conversion to ileal conduit at a mean of 2.1 years after initial ileovesicostomy due to urethral incontinence. DLPP was less than 20 cm H2O in all of these patients. Urodynamics study (UDS) was performed in the remaining 26 patients with at least one UDS performed a minimum of ten years after initial ileovesicostomy. Initial DLPP in this cohort was 68 +/- 21 cm H2O. With an extended follow-up of greater than ten years, DLPP on last follow-up was 12 +/- 4 cm H2O. Of these 26 patients, intermittent catheterization is utilized at least once daily due to stasis with recurrent UTI (6/26 patients) and UTI with mild hydronephrosis in (2/26 patients). All of these patients have functioning ileovesicostomy with a DLPP of less than 20 cm H2O.

In this series of patients with ileovesicostomy the authors reports, nearly 40% of patients will require the addition of intermittent catheterization after ten years despite low pressure drainage of the bladder through a functioning ileovesicostomy.

They hypothesized that complications such as recurrent urinary tract infections are in part related to urinary stasis within the bladder and that although low pressure storage is achieved, there remains significant residual urine within the bladder.

Presented by: Mihir Shah, MD
Co- Authors: Ali Syed MD, Alana Murphy MD, Akhil Das MD and Patrick Shenot MD
Author Information: Thomas Jefferson University Hospital, Sidney Kimmel Medical School, Philadelphia, PA

Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas