Presentation Authors: Nuno Grilo*, Paris, France, Christine Reus, Stockholm, Sweden, Véronique Phé, Cyrille Guillot-Tantay, Louise Alechinsky, Emmanuel Chartier-Kastler, Paris, France
Introduction: The objective of this study is to analyze the outcome of bladder neck/urethral closure as a treatment option for neurogenic and malformative stress incontinence in women with a continent cutaneous diversion (CCD).
Methods: This single-center historic database included 233 patients (167 females and 66 males) with a CCD, performed between 2001 and 2017. Fourteen female patients underwent a bladder neck/urethral closure. Data on patient and surgical characteristics, previous stress incontinence surgeries and full urethral continence at last follow-up were analyzed.
Results: A total of 10 transabdominal and 4 transvaginal bladder neck/urethral closure procedures were performed. Seven of the 14 patients failed previous stress urinary incontinence procedures before undergoing bladder neck/urethral closure. From the 7 patients with no prior history of anti-incontinence surgery, 3 presented bladder neck and urethral destruction due to long-term indwelling catheter, 2 presented an extensive urethral fibrosis owed to multiple reconstructive procedures in childhood and another underwent a previous cervicotomy. There were no major procedure-related complications. One patient presented an early vesico-vaginal fistula 18 days postoperatively. Resolution was achieved after 3 months of conservative management with suprapubic catheter. After a median follow-up of 5,4 years, three patients required a CCD revision and 1 patient needed an endoscopic followed by 2 open cystolitholapaxy at a later stage. At last follow-up, urethral continence was achieved in all 14 patients, with only one necessitating an additional vesico-vaginal fistula repair with a Martius flap. A multiple sclerosis patient underwent an ileal conduit due to significant upper limb function loss 7 years after bladder neck closure.
Conclusions: In summary, achieving urethral continence is challenging but crucial for the management of patients with a CCD. In our experience, bladder neck/urethral closure provided good long-term results, regardless of the surgical approach. It is, therefore, a valid option in females with a continent cutaneous diversion suffering from refractory urinary incontinence.