Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis. Issue 2 (17th January 2020)

• Record Type: Journal Article
• Authors: Akakpo, William; Chartier‐Kastler, Emmanuel; Joussain, Charles; Denys, Pierre; Lubetzki, Catherine; Phé, Véronique
• Is Part Of: Neurourology and urodynamics. Volume 39:Issue 2(2020:Feb.)
• Page Start: 771
• Page End: 777
• Publication Date: 2020-01-17
• Subjects: complications -- ileal conduit -- multiple sclerosis -- surgery -- urinary diversion -- urinary incontinence; Urinary organs -- Periodicals; Urodynamics -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1002/nau.24279
• Languages: English
• ISSNs: 0733-2467

Abstract

Abstract: Aim: The objective of this study was to report the long‐term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). Material and Methods: A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long‐term complications, reoperation rates, and renal function. Results: Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow‐up was 50 months (range, 3‐158 months). A significant reduction ( P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function ( P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. Conclusion: Noncontinent urinary diversion using ileal conduit appears to be an effective end‐stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.