The Impact of Transtomal Rigid Endoscopy IN Continent Cutaneous Urinary Diversions

To evaluate the use of rigid endoscopes through the stoma of continent cutaneous urinary diversions and its effect on the continence mechanism. We report the largest and longest series to date from a single institution demonstrating the safety of transtomal rigid endoscopy.

An IRB approved retrospective review of a prospectively accrued database of all patients with urinary diversions that underwent rigid endoscopic procedures for various reasons between 2000-2013. Pre and postoperative continence, difficulty with catheterization, and need for surgical revision post procedure were evaluated.

From 2000-2013, 71 patients with continent cutaneous diversions underwent 191 endoscopic procedures by a single surgeon. Mean follow-up was 603 days. Mean age was 58. 4yrs. The mean number of procedures per patient was 2. 7 (1-7). All procedures were performed by gaining access through the stoma with an offset rigid nephroscope and a 28-30Fr access sheath. Two patients reported continence issues post operatively; one patient was treated conservatively by way of indwelling catheter for one week and full continence returned. The second patient had small volume incontinence pre-operatively which worsened postoperatively. The procedure uncovered an existent efferent limb-cutaneous fistula. Patients with repeated procedures were not found to be at any higher risk of incontinence. There were no patients that had difficulty with catheterization post operatively. No surgical revisions were required for worsened continence post operatively.

Transtomal rigid endoscopic procedures do not negatively affect the continence mechanism in continent cutaneous diversions. Transstomal rigid endoscopy allows for safe endoscopic access in these difficult to treat patients.

Urology. 2015 Oct 05 [Epub ahead of print]

Charles Metcalfe, Jeffery Loh-Doyle, Sameer Chopra, Andre L Abreu, Raj Satkunasivam, Raed Azhar, Vannita Simma-Chiang, Matthew Dunn

U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A. , U. S. C. Institute of Urology, University of Southern California, Los Angeles, California, U. S. A.  

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