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PubMed1999

Lifestyle factors and continence status: comparison of self-report data from a postal survey in England.

OBJECTIVE: To compare health and lifestyle factors of people with and without urinary incontinence (UI). DESIGN: A postal survey was undertaken that represents the first of a 3-stage project designed to evaluate the health interventions of primary health care teams and continence advisory services on patient outcomes related to UI. SETTING AND SUBJECTS: Two random samples of adult populations (N = 12,529) were included, generated from the family physician patient registers within 2 health authorities in England. INSTRUMENTS: Data were collected using a structured questionnaire that queried demography, perceived health status, activities of daily living, self-care, and use of local health and social services. Information was also collected on past and present continence status. METHODS: Structured questionnaires and a cover letter were mailed to the target population. Two reminders were sent to nonresponders to maximize the response rate. MAIN OUTCOME MEASURES: The main measures relate to factors associated with UI: mobility, sleep, childbirth, smoking, diet, body mass index, and accommodation. RESULTS: Significantly more women than men had UI (P < .0001). Respondents with UI were older than those who were continent (P < .0001). Women with UI were significantly more likely to have a greater number of pregnancies (P < .0001), were more likely to have given birth to a baby weighing more than 9 lb (P < .01), and to have had more than 4 children (P = .01) compared with women who were continent. People with UI were less likely to be single and more likely to be widowed than those who were continent (P < .0001). People who lived alone and who had UI were also significantly less likely to have a relative or friend that they could depend on for help than those who were continent (P < .001). UI was also found to be significantly associated with impaired mobility (P < .0001) and sleeping difficulties (P < .0001). No meaningful differences were found between diet and UI, although significantly more people with UI had higher mean body mass index, were obese, or reported that they felt too heavy for their height when compared with people who were continent (P < .0001). No association was found in the present study with smoking or ethnicity and UI. CONCLUSIONS: Key health and lifestyle factors associated with UI included age, gender, childbirth, mobility, sleep patterns, obesity, living alone, and access to help. These factors should be assessed when planning and implementing health care for persons with UI. Attention to these associated factors may prove useful in identifying new cases or people at risk of developing UI when screening people as part of routine health checks. This, in turn, could assist with targeting effective and efficient health care but may also contribute to prevention for some people.

Activities of Daily Living↗

PubMed2003

Differences in estrogen modulation of tissue inhibitor of matrix metalloproteinase-1 and matrix metalloproteinase-1 expression in cultured fibroblasts from continent and incontinent women.

OBJECTIVE: The purpose of this study was to investigate the effect of increasing estrogen concentrations on metalloproteinase and tissue inhibitors of metalloproteinase protein expressions in cultured pelvic fibroblasts that were obtained from continent and incontinent women. STUDY DESIGN: Periurethral vaginal wall tissues were taken from four stress incontinent and three continent premenopausal women who underwent gynecologic surgery for benign indications. Protein was extracted from these tissues, and Western blot analysis was performed to document that fibroblasts from continent and incontinent women differed with respect to metalloproteinase and tissue inhibitors of metalloproteinase production. One age-matched tissue pair was prepared for fibroblast culture. Cells were cultured with increasing concentrations of estradiol (0-500 pg/mL). Extracellular metalloproteinase and tissue inhibitors of metalloproteinase were assessed semiquantitatively with Western blotting. RESULTS: Periurethral vaginal tissues from incontinent women expressed less tissue inhibitors of metalloproteinase when compared with tissue from the control subjects; there was no difference in the expression of cleaved, active metalloproteinase protein. Tissue inhibitors of metalloproteinase expression from fibroblasts of continent women significantly increased with increasing estradiol concentrations (0-100 pg/mL, P <.05). No significant dose response was seen in fibroblasts from an incontinent woman. Metalloproteinase expression was not altered by increasing estradiol concentrations in fibroblasts from either continent or incontinent women. CONCLUSION: This preliminary in vitro study suggested that, in fibroblasts that were derived from the continent woman, tissue inhibitors of metalloproteinase protein production increases with increasing estrogen levels and that, in stress incontinent fibroblasts, no similar increase occurs. Neither group demonstrated a change in metalloproteinase production in response to varying estrogen levels, which suggests that estrogen may inhibit collagen degradation in continent women by increasing tissue inhibitors of metalloproteinase production but exerts a reduced inhibitory effect on collagenolysis in women with stress urinary incontinence.

Adult↗

PubMed2004

Continent urinary diversion: 10-year experience of Shriners Hospitals for Children in Chicago.

PURPOSE: To review long-term functional results, complications, and patient satisfaction in patients with a continent catheterizable urinary diversion. MATERIALS AND METHODS: A retrospective chart review and telephone satisfaction interviews were conducted. Bladder dysfunction was attributed to neurogenic bladder (n = 48: 23 spinal cord injury, 18 myelomeningocele, 4 sacral agenesis, 3 cerebral palsy), bladder exstrophy (n = 2), posterior urethral valves (n = 1), and other (n = 3). Patients underwent continent urinary diversion with either the Mitrofanoff principle (appendicovesicostomy, n = 47) or a Monti tube (ileovesicostomy, n = 8). Outcomes were assessed by chart review. Patient satisfaction was assessed by telephone interview and scored from 1 to 10 on a Likert-type scale. RESULTS: Between 1992 and 2003, 54 continent urinary diversions were performed on 17 boys and 37 girls. Mean age was 15.3 years (range, 7-21 years). An umbilical stoma was created in all patients. Seventy-three percent (40/54) and 47% (26/54) underwent concomitant bladder augmentation and urethral sling procedure, respectively. Mean follow-up was 2.5 years (range, 3 months to 10 years). Ninety-five percent (51/54) of patients were continent, and 5% (3/54) were incontinent from the umbilical stoma after one operation. All were compliant with intermittent catheterization. Complications included bladder calculi (15%; 8/54), stomal stenosis (9%; 5/54), stomal bleeding (5%; 3/54), small bowel obstruction (2%; 1/54), and superficial wound dehiscence (2%; 1/54). Seventy-three percent (40/54) of patients were available for telephone interview. Of these, 90% (36/40) reported satisfaction, and 10% (4/40) reported dissatisfaction; 93% (37/40) reported that they would recommend the procedure to others, whereas 7% (3/40) would not. CONCLUSION: In our series, continent urinary diversion with the Mitrofanoff principle or Monti tube is associated with high continence, compliance, and satisfaction rates and a low complication rate. An umbilical stoma was achievable in all patients. Our 10-year experience is consistent with other reported series and underscores the successful long-term outcome and durability of continent urinary diversions.

Adolescent↗

PubMed2006

Laparoscopic antegrade continence enema using a two-port technique.

BACKGROUND: The antegrade continence enema is an effective method of treatment of fecal incontinence. We report our experience of a laparoscopic antegrade continence enema procedure and describe a simple approach to this procedure using a two-port technique. MATERIALS AND METHODS: Over a 3-year period, 12 children with intractable constipation and fecal soiling underwent the antegrade continence enema procedure laparoscopically. All cases had full bowel preparation the day before surgery. This procedure was done through one 5-mm camera port and two 5-mm working ports in 8 cases, and using the camera port and only one additional 5-mm working port in 4 cases. The appendix was used in 5 cases and the cecum in 3 cases with the threeport technique while the appendix was used in all 4 cases with the two-port technique. The appendix or cecum was delivered extracorporeally through the 5-mm port site in the right lower quadrant. The mucocutaneous anastomosis was stented using a gastrostomy button. RESULTS: Between 2001 and 2004, 12 children (10 male, 2 female) underwent a laparoscopic antegrade continence enema procedure at a median age of 10.5 years (range, 7-14 years). This procedure was easy to perform and no case required conversion to an open procedure. The wash-outs via the MIC-KEY gastrostomy button (MIC-KEY, Kimberly-Clark) were commenced at a median of 3.5 days (range, 1-5 days). Median postoperative hospital stay was 2 days (range, 1-5 days). This procedure was effective in completely resolving fecal incontinence in 9 cases and partially resolving it in 3 cases. There were no episodes of stomal stenosis, leakage, or herniation. However, one case required a revision of antegrade continence enema due to wound breakdown and leakage of irrigation fluid around the stoma. The median follow-up period was 15.5 months (range, 5-32 months). CONCLUSION: The laparoscopic technique is a simple and effective approach in creating an antegrade continence enema. The use of a gastrostomy button can potentially reduce some of the complications commonly associated with an antegrade continence enema. We describe a procedure that incorporates the advantages of both laparoscopy and a button device, which is simple and easy to perform using just two ports.

Adolescent↗

PubMedDate not supplied

Use of morphine sulfate (MS Contin) in patients with burns: a pilot study.

Morphine sulfate (MS Contin), a proven analgesic in the treatment of cancer pain and chronic benign pain, seems to be a good analgesic for the treatment of burn pain. MS Contin is morphine sulfate incorporated in a wax cellulose matrix delivery system. This wax cellulose delivery system gives MS Contin its duration of action. Ten patients were enrolled in an open-labeled, nonrandomized study. The study was designed to examine the analgesic efficacy of MS Contin in the burn population. Each patient remained in the study for 6 days. The efficacy of the analgesic regimen was subjectively measured by the visual pain scale. The MS Contin group was retrospectively compared with a group of patients who were given continuous intravenous infusions of morphine. The two groups were matched according to age, burn size, surgical procedures, and hospital stay. The analgesic qualities of MS Contin were comparable to those of continuous intravenous morphine sulfate infusions. MS Contin is a possible candidate for the treatment of patients with burn pain because of its analgesic qualities, oral dosing, and duration of action.

Adolescent↗

PubMed1997

Role of the antegrade continence enema in the management of the most debilitating childhood recto-urogenital anomalies.

PURPOSE: We evaluated the antegrade continence enema for managing the most severely compromised fecal continence mechanisms and the efficacy of nonappendiceal conduits in children when appendix is unavailable. MATERIALS AND METHODS: Ten patients 3 to 25 years old underwent continent cecostomy for the purpose of the antegrade continence enema. Diagnoses included the VATER association in 4 cases, myelomeningocele in 3, cloacal anomaly in 2 and isolated imperforate anus in 1. Eight patients received a tubularized ileal conduit, 2 received an appendiceal conduit and 2 underwent concomitant fecal undiversion. RESULTS: Followup ranged from 4 to 28 months (mean 17.6). All patients have achieved excellent fecal continence and no significant stomal soilage or difficulty with catheterization has been noted. Patients reported a high degree of satisfaction. CONCLUSIONS: Continent cecostomy for the antegrade continence enema is highly effective even in the presence of severe structural anorectal disease. The tapered ileal conduit is an excellent alternative to the appendiceal conduit.

Abnormalities, Multiple↗

PubMed1998

Urologic intestinal reservoirs: the continent outlet.

General use of standardized terminology and assessment of functional characteristics suggested by the International Continence Society will enable better comparison of the results and technical specifications of different continent outlets. According to the basic functional principle, continence mechanisms can be classified into extraluminally and intraluminally located continent outlets. Extraluminal continent outlets are easy to construct, but are associated with the risk of overflow incontinence. The use of invagination or intussusception nipple valves is associated with a long learning curve, tedious surgical technique and high complication rate. There is an increasing tendency to use the flap valve principle for construction of continent outlets, which guarantee a high rate of complete continence with an acceptable complication rate.

Journal Article↗

PubMed2004

The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments.

PURPOSE: We determined the impact of radical retropubic prostatectomy on continence and lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon, and completed the UCLA Prostate Cancer Index and American Urological Association (AUA) symptom index at baseline, 3, 6, 12 and 24 months after radical prostatectomy. Univariate analysis was performed to identify factors predisposing the early return of continence. RESULTS: A total of 100%, 98.3%, 97.1%, 94.2% and 98.6% of patients filled out the UCLA Prostate Cancer Index and AUA symptom index at baseline, and 3, 6, 12 and 24 months, respectively. Based on protective pad requirement or frequency of incontinence 100%, 90.9%, 87.2%, 92.1% and 98.5% vs 98.8%, 80.6%, 91.2%, 95.2% and 98.5% of men were continent at baseline, 3, 6, 12 and 24 months after surgery, respectively. Age, severity of lower urinary tract symptoms, Gleason score, nerve sparing status, blood loss or presence of benign prostatic tissue in the apical soft tissue margin did not predict early return of continence. All of the individual urinary symptoms captured by the AUA symptom score showed significant improvement after radical retropubic prostatectomy. Radical prostatectomy was associated with a mean 5.4 unit decrease in AUA symptom score (40% decrease) in men with baseline moderate/severe LUTS (AUA symptom score 8 or greater). CONCLUSIONS: The majority of men regain continence after radical retropubic prostatectomy and maximal continence is achieved by 24 months. No factors were identified that predicted early return of continence in our cohort of men undergoing radical prostatectomy. Radical prostatectomy has a clinically significant impact on improving LUTS.

Humans↗

PubMed1995

A postal survey of continence advisers in England and Wales.

Improved continence services have been identified as a purchasing priority for 1994-1995. A key figure in the continence team is the nurse continence adviser. However, although the Association for Continence Advice in the United Kingdom offers a set of guidelines for the role of continence adviser, the extent to which these were implemented across the country was unknown. In 1991, the Department of Health commissioned the Social Policy Research Unit of the University of York, England, to carry out a postal survey of all known continence advisers in England and Wales in order to provide basic quantitative information about the number of advisers in post, their professional qualifications, the structures in which they worked, and the nature of current practice. In this paper a brief resumé of some of the main findings from the survey, which included both quantitative and qualitative data, is presented. The role of the continence adviser as a clinical nurse specialist and some of the implications for current practice are also discussed.

Adult↗

PubMed2006

Do nurses promote urinary continence in hospitalized older people?: An exploratory study.

AIM: The aim of this paper is to explore whether nurses working in elderly medicine and in acute medical settings promote urinary continence in older people or in reality use containment strategies. BACKGROUND: Untreated urinary incontinence in older adults can result in prolonged hospital admission and increased risk of admission to long-term care. Urinary incontinence can also have severe psychosocial effects on older people. Most studies relating to this topic have relied on quantitative approaches to data collection with a seeming lack of qualitative investigation into how nursing staff promote urinary continence in hospitalized older people. METHOD: Focus groups and one-to-one semi-structured interviews were carried out in two NHS regions in Scotland. Registered and non-Registered Nurses were invited to participate. Five focus groups (n = 17) and four single interviews (n = 4) were conducted. Data generated were analysed thematically using QSR N-VIVO 2. FINDINGS: Some nurses believe that older people accept urinary incontinence as a consequence of ageing. Lack of assessment results in older people being labelled as incontinent of urine. Assessment strategies in medicine for the elderly tend to focus on product identification and management of incontinence. Although nurses from all clinical areas identify the importance of promoting continence, the problem continues to be contained rather than treated. Conflicting clinical priorities, varying staff approaches to urinary continence and deficits in education are cited among the barriers to promoting continence. CONCLUSIONS: The results suggest that nurses continue to contain urinary incontinence rather than promoting continence in older people. RELEVANCE TO CLINICAL PRACTICE: Nursing staff need to be aware of the impact of untreated urinary incontinence on older people. Practitioners should promote continence rather than employing containment strategies. A validated assessment tool for older people needs to be developed. Views of older people should be sought regarding their attitudes towards urinary incontinence.

Age Factors↗

PubMed2000

Prognostic factors for long-term maintenance of urinary continence in patients with incontinence managed by diapers or indwelling catheters.

OBJECTIVE: We examined the prognostic factors for longterm maintenance of continence following nonsurgical treatments in hospitalized patients with urinary incontinence. METHODS: 313 inpatients (average age: 64 years) in whom urinary incontinence had originally been managed with diapers (n = 158) or indwelling Foley catheters (n = 155) first received nonsurgical rehabilitative treatments. The patients who became continent with these treatments were then evaluated for being either continuously continent or recurrently incontinent during the 5-year follow-up period after discharge from hospital. A multivariate logistic regression analysis was then performed to determine significant risk factors for recurrent urinary incontinence. RESULTS: By initial treatments (mean duration: 144 days), 294 of the 313 patients (94%) were continent and free from diapers or catheters. After the 5-year follow-up period, urinary continence was maintained in 103 (66%) and 62 patients (45%) initially managed with diapers (n = 157) and catheters (n = 137), respectively. Multivariate logistic analysis revealed that in both patient groups, poor posttherapeutic activities of daily living or loss of home care service lowered the maintenance rate of continence. Dementia also lowered the maintenance rate in patients with catheters, but not in those with diapers. In addition, a long history of Foley catheter drainage for over 1 year prior to the initial treatment reduced the maintenance rate (highest odds ratio). CONCLUSIONS: Physical disability and poor therapeutic assistance at home are more prominent risk factors for long-term maintenance of urinary continence in elderly patients than problems within the urinary tract.

Aged↗

PubMedDate not supplied

Educational preparation: specialist practice in continence care.

Contributing factors to effective continence service provision include funding, organization, and expert knowledge among the individuals providing care. Expert knowledge can be gained through clinical experience and appropriate ongoing education. It has been widely reported that undergraduate education in this area for nurses, doctors and physiotherapists is limited (Brocklehurst, 1990; Swaffield, 1994; Laycock, 1995). Many nurses providing continence care have accumulated knowledge through experience and trial and error. Little is known about the effectiveness of advanced postgraduate education of 'experts' in continence care. This article outlines a continence education module developed to prepare a specialist group of nurses to provide a high standard of continence care that is both safe and effective in a clinical environment. This module was designed and evaluated specifically as part of the Leicestershire Medical Research Council (MRC) Incontinence Study. Changes in continence knowledge, attitudes to research, and acceptability of the module have been explored. When setting up a new nurse-led continence service, it is of great importance to systematically detail the components of the educational preparation of the nurses providing the service. Open discussion of any problems in the design and implementation of this module may inform future modules in this and other areas.

Attitude of Health Personnel↗

PubMed2003

Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up.

OBJECTIVE: To compare the efficacy and labour costs of nurse continence advisors and urogynaecologists in conservative management of urinary incontinence. DESIGN: Single centre randomised controlled trial of patients with mild or moderate leakage. SETTING: Tertiary urogynaecology unit. SAMPLE: One hundred and forty-five consecutive patients with stress and/or urge incontinence. METHODS: Standardised conservative therapy regimens, provided by nurse continence advisors and urogynaecologists. MAIN OUTCOME MEASURE: One-hour pad test, frequency volume charts, a 20-point incontinence score and two quality of life tests, staff treatment times and costs. RESULTS: Of 110 women who completed 12-week treatments, 64% of the women in the nurse continence advisor group (n = 58) and 52% of women treated by urogynaecologists (n = 52) were asymptomatic (dry pad test; OR 1.63, 95% CI 0.71-3.75). There was no significant difference between clinician groups for change in pad test result (P = 0.71), voids/day (0.43), incontinence score (P = 0.57) or quality of life scores (urogenital distress inventory, P = 0.27; Incontinence Impact Questionnaire, P = 0.41). Despite the expected longer consultation times for the advisor group (median 160 min, interquartile range [IQR] 130-210) versus the urogynaecologist group (median 90 min, IQR 60-120), the per capita labour cost for advisor treatment (median AU$59.20, IQR 48.10-77.70) was lower than for treatment given by urogynaecologists (median cost AU$ 189.70, IQR 120.60-250.70, Mann-Whitney U test, P < 0.0001). At 2.5 years, 23/58 patients (40%) treated by advisor and 27/52 patients (52%) treated by urogynaecologist group, who had been cured and discharged, were available for contact. Of these, 29% of women in the nurse continence advisor group and 41% of those treated by urogynaecologists remained continent (on 20-point score). Quality of life improvement persisted equally in both groups. These data should be interpreted cautiously due to a 24% dropout rate. CONCLUSIONS: The reduction in urine leakage and improvement in quality of life observed in patients treated by nurse continence advisors and urogynaecologists were similar at 12 weeks and 2 years, but lower costs arose from treatment provided by nurse advisors. We suggest that conservative treatment by the nurse continence advisor could be used more widely in mild to moderate incontinence.

Aged↗

PubMed1990

Complications, surgical revision and quality of life with conventional and continent ileostomy.

Continent ileostomy remains an alternative to restorative proctocolectomy in selected cases. Results with continent ileostomy in 55 patients are reported--in 82% after conversion from conventional ileostomy. Three years postoperatively 93% were continent and 7% partially continent, and after 5 years 95% were continent. Complications requiring laparotomy arose in ten patients (18%) during the immediate postoperative period (30% among the first 27 patients, 7% of the subsequent 28). The incidence of late complications requiring laparotomy was 16% in the first year, 10% in the next 2 years and 5% after the third year. Slipping of the nipple occurred in 9% of the patients in the first postoperative year. No reservoir has been removed. The quality of life improved after colectomy with conventional ileostomy, but most patients experienced a dramatic further improvement after construction of the continent ileostomy. The improvement in ultimate quality of life was not influenced by revision for malfunction of continent ileostomy.

Adolescent↗

PubMed1989

Continent reservoirs.

Continent urinary diversion is a major advance in the treatment of selected patients following cystectomy. Twenty-eight patients have undergone some form of continent urinary diversion at Yale New Haven Hospital during the past three years; thirteen have a continent reservoir with a continent stoma on the abdominal wall, and empty the urine by self-intermittent catheterization, and 15 have a reservoir anastomosed to the urethra, the majority of whom void spontaneously. All are continent by day and over 50% are continent at night. A recent modification in the construction of the urinary reservoir would appear to have resolved the problem of nocturnal incontinence. The results and urodynamic studies in this group of patients are discussed, and it is concluded that a detubularized intestinal reservoir provides a safe and effective method for continent urinary diversion in selected patients following cystectomy.

Adolescent↗

PubMed1989

[Indiana continent urinary reservoir: report of 15 cases].

Over the last several years, internal reservoir type urinary diversions have become popular. We have already performed Kock continent ileal reservoir for urinary diversion in more than 80 patients. The experience with the Kock pouch prompted us to try a new form of continent urinary reservoir originally reported by Indiana University group. The Indiana pouch is a composite structure using ileum and cecum. The antireflux mechanism is provided with tunneled ureteral implantation along the tenia of the cecum. Plication of the terminal ileal segment along with the ileocecal valve maintains urinary continence. The tubular configuration of the cecum is completely disrupted with either an ileal patch or Heineke-Mikulicz re-configuration to construct a low pressure reservoir. Between October, 1987 and September, 1988, we performed Indiana continent urinary diversion in 15 cases: 13 males and 2 females, from 47 to 73 years old (mean age 61.3 years), 14 bladder cancer patients and 1 bladder sarcoma patient. The initial 8 patients underwent Heineke-Mikulicz type operation and the subsequent 7 patients ileal patch-type operation. Median followup has been 7 months. There were no major early complications but one postoperative death with blood transfusion related graft versus host disease (GVHD). The late complication occurred in 2 patients: 1 stenosis of the pouch due to insufficient detubularization of the cecum and 1 pyelonephritis required no admission. Serum electrolytes and vitamin B12 remained normal in all patients. Patients perform self-catheterization every 3-5 hours during the day and 0-2 times at night for volumes ranging up to 800 ml. With regard to volume capacity and pressure characteristics, the ileal patch type reservoir seemed to be superior to the Heineke-Mikulicz type pouch as a receptacle for urine. Over-all, 12 of 14 patients (86 per cent) have acceptable continence. The remaining 2 patients have significant daytime leakage requiring pads or a cutaneous bag. Followup examination with excretory urography showed no upper tract obstruction and X-rays of the pouch showed no reflux. Indiana pouch is a relatively simple continent urinary reservoir, since the steps of this technique already are familiar to urologists. It may be an alternative form of continent urinary diversion.

Aged↗

PubMed1986

[The Kock continent ileal urinary reservoir: surgical technic and clinical results].

From July 1985 through January 1986, 43 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception and fixation of the nipple valves to prevent reflux and to ensure continence. A strip of PGA mesh serves as a collar to fix the afferent-efferent limb to the pouch once the intussusception technique has been accomplished. The use of a narrow Marlex strip allows fixation to the abdominal wall both lateral and medial to the stoma site (insert). This strip is important in preventing a parastomal hernia and helps fix the continence valve mechanism to the posterior abdominal wall. Previous urinary diversion was by ureterosigmoidostomy in 2 patients, standard ileal conduit in 8 and chronic dialysis after nephrectomy of solitary kidney and cystectomy in 1. A total of 32 patients underwent simultaneous anterior exenteration or radical cystectomy for pelvic malignancy. There were 4 postoperative deaths and early complications occurred in one patient. Late complications occurred in only 3 patients: they required reoperation and revision of the continence valve mechanism. The end result in 39 of 43 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electolytes have remained normal in all patients. X-ray of the Kock pouch have shown no evidence of reflux, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir. During the same time, 21 patients out of 278 patients who underwent creation of a Kock continent ileal urinary reservoir since August 1982, underwent revision of Kock pouch. Two of those required subsequent reoperation and revision of the continence valve mechanism. The end result in all patients has been an overwhelming success.

Adult↗

PubMed1995

Use of ileocecal continent urinary reservoir in patients with previous pelvic irradiation.

OBJECTIVE: To assess the results of the use of ileocecal continent urinary reservoirs in patients with previous pelvic irradiation. METHODS: A retrospective analysis for morbidity and clinical outcome was undertaken for 37 female patients with prior therapeutic pelvic irradiation who underwent continent urinary diversion with a detubularized right colonic segment as the urinary reservoir, a plicated ileocecal valve as the continence mechanism, and a tapered distal ileum for efferent catheterization. RESULTS: Thirty-one patients had persistent or recurrent pelvic malignancies, 17 of whom had total pelvic exenteration and 14 had anterior exenteration. The remaining 6 patients had radiation-induced vesicovaginal fistulas without evidence of recurrence and underwent urinary diversion alone. Follow-up ranged from 2 to 33 months (median 11 months). Postoperative radiographic evaluation revealed no evidence of urinary extravasation. Of the 74 implanted ureters, 4 had reflux (5%), 2 developed stricture (3%), and 5 had mild to moderate hydronephrosis (7%). All patients achieved daytime continence with catheterization intervals of 3-8 hr (median 4 hr) and capacities of 200-1000 cc (median 500 cc). Nighttime continence was reported by 33 of 37 patients (89%). Reoperation was required in 3 patients (8%), 2 with stoma stenosis and 1 with difficulty in catheterization. CONCLUSIONS: The use of the ileocecal continent urinary reservoir in patients with previous pelvic irradiation achieves results comparable to those reported for nonirradiated patients, thus supporting its use in this select group of patients.

Female↗