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EVALUATION AND MANAGEMENT OF MECHANICAL DYSFUNCTION IN CONTINENT COLONIC URINARY RESERVOIRS

2000; Lippincott Williams & Wilkins; Volume: 163; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(05)67519-2

1527-3792

Raul Ordorica, Jonathan L. Masel, John D. Seigne, Lester Persky, Jorge L. Lockhart,

Urinary Tract Infections Management

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jun 2000EVALUATION AND MANAGEMENT OF MECHANICAL DYSFUNCTION IN CONTINENT COLONIC URINARY RESERVOIRS RAUL C. ORDORICA, JONATHAN MASEL, JOHN SEIGNE, LESTER PERSKY, and JORGE L. LOCKHART RAUL C. ORDORICARAUL C. ORDORICA More articles by this author , JONATHAN MASELJONATHAN MASEL More articles by this author , JOHN SEIGNEJOHN SEIGNE More articles by this author , LESTER PERSKYLESTER PERSKY More articles by this author , and JORGE L. LOCKHARTJORGE L. LOCKHART More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67519-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We analyze a group of patients who presented with mechanical dysfunction of the reservoir and/or efferent limb of a continent colonic urinary diversion, and establish an evaluation and management algorithm. Materials and Methods: A total of 16 patients with a mean age of 58 years and 1 or more symptoms related to continent colonic urinary diversion were evaluated. Presenting symptomatology included difficult catheterization in 8 cases (50%), disabling incontinence in 8 (50%) and recurrent urinary tract infections in 6 (37.5%). All patients had normal, nonobstructed, nonrefluxing upper tracts and none presented with stone disease. Urological evaluation consisted of catheterization, fluoroscopy and urography of the pouch, retrograde urography of the external limb and urodynamics (enterocystometrogram and outlet pressure profilometry). Results: Of the 8 patients with difficulty with catheterization 4 had stomal stenosis, 2 had an elongated and redundant external limb, and 2 had a false passage. Diagnosis was established by the inability to catheterize, fluoroscopy of the pouch and retrograde urography. Disabling incontinence occurred in 8 patients, including 7 who presented with an incompetent outlet and 2 with high pressure intestinal contractions of the reservoir. The aforementioned abnormalities were diagnosed by a combination of retrograde urography, urography of the pouch and urodynamics. Recurrent symptomatic urinary infections were observed in 5 patients of the previous groups and in another with an hourglass reservoir, which was primarily diagnosed by urography of the pouch. Surgical correction in 15 patients included outlet reinforcement, reservoir revision, stomal or external limb revision and conversion to a urinary conduit. Surgical treatment was successful in 14 of 15 patients (93%). Conclusions: Catheterization difficulty requires retrograde urography to define possible anatomical abnormalities (false passage, conduit elongation) if catheterization and fluoroscopy of the pouch do not demonstrate stomal stenosis. Urinary incontinence benefits from enterocystometry and outlet pressure measurement to determine reservoir and external limb function. Recurrent urinary tract infections not related to ureteral obstruction or reflux requires fluoroscopy of the pouch and external limb to determine abnormalities in patients with detubularization and localization of areas of urine pooling. References 1 : The cecoileal continent urinary reservoir. World J Urol1985; 3: 185. Google Scholar 2 : An alternative method for continent supravesical diversion. Soc Pediatr Urol Newsl1987; 3: 18. Google Scholar 3 : Urinary diversion via a continent ileal reservoir: clinical results in 12 patients. J Urol1982; 128: 469. Link, Google Scholar 4 : Continent urinary diversion. J Urol1989; 141: 1323. Link, Google Scholar 5 : The Florida pouch procedure: six year follow-up. J Urol1995; 153: 241A. abstract 50. 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Volume 163Issue 6June 2000Page: 1679-1684 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsurinary tract infectionscatheterizationurinary diversionurinary incontinenceurinary reservoirs, continentMetricsAuthor Information RAUL C. ORDORICA More articles by this author JONATHAN MASEL More articles by this author JOHN SEIGNE More articles by this author LESTER PERSKY More articles by this author JORGE L. LOCKHART More articles by this author Expand All Advertisement PDF downloadLoading ...