How to Manage a Dysfunction of the Efferent Segment in Continent Cutaneous Urinary Diversion (Hydraulic Reservoir)? A Retrospective Study of 10 Cases

ABSTRACT

"Continent cutaneous reservoirs after cystectomy remain an invaluable treatment option for a well-defined subset of indications. The continence mechanism largely determines the treatment success in terms of patient satisfaction and quality of life. Any dysfunction is considered a failure by both patients and surgeons. A retrospective study was made from 2003 to 2013 (13 years) with the aim to characterize the hydraulic valve dysfunction in patients who underwent a cystectomy with continent urinary pouch. A total of ten patients were included in this study. The main age was 44 years. The indications of cystectomy were pelvic tumors (62%); vesico-vaginal fistulas (20%); bladder extrophy (10%); hypospadias (4%) and complicated uretral strictures (4%). An hydraulic continent valve according the Benchekroun process was made for all our patients. After a median follow-up of 36 months; the main related efferent segment complications were fistulas in the top of the valve or ""pinhole fistula"" in 25% of cases; the externalized prolapse of disinserted valve in 25% of cases; and the progressive desinvagination with urinary incontinence in 50% of cases Continent catheterizable urinary diversion remains a treatment option for a well-defined subset of indications. There is little consensus regarding the different options for the efferent segment; which has the greatest influence on patient satisfaction."