ABSTRACT
BACKGROUND: Neuropathic bladder, voiding dysfunction, and posterior urethral valves may cause a great challenge in children. Preserving the kidney function is the main aim in all of these patients which can be achieved by cutaneous vesicostomy. OBJECTIVE: The objective of this study is to evaluate the long-term outcomes of patients who have undergone cutaneous vesicostomy in an 11-year period at the study center. STUDY DESIGN: In this retrospective study, the authors evaluated the long-term treatment results and complications of cutaneous vesicostomy on children with bilateral severe hydronephrosis, bilateral vesicoureteral reflux (VUR), and urosepsis who were operated at our center from 2007 to 2018. RESULTS: There were 64 (80%) boys and 16 (20%) girls. Their mean of age was 15.27 months old when they underwent vesicostomy. Twenty-three (28.75%) of them had neurogenic bladder and 17 (21.25%) of them had intact neuronal pathway defined as dysfunctional voiding. Twenty-five (31.25%) boys had posterior urethral valves. Fifteen (18.75%) of them were younger than six months old with primary bilateral high-grade VUR and urosepsis. Mean of follow-up time was 65.34 ± 37.82 months (11.5 months-10.5 years). Cure rate was 95% in urinary tract infection, 80.7% in secondary VUR, and 40% in primary VUR. Creatinine level was significantly reduced after vesicostomy and during follow-up (P < 0.001). Complications after vesicostomy were stoma stenosis (11.25%), mucosal prolapse (7.5%), dermatitis (3.75%), and febrile urinary tract infection (5%). In primary VUR after vesicostomy, 60% of the patients did not require an intervention to correct the reflux (Table). DISCUSSION: A number of 29 of 66 patients with closed vesicostomy needed another surgery: three modified Gil-Vernet antireflux surgeries, one ureteral reimplantation, two endoscopic Deflux injections, 13 valve ablations, six ileocystoplasties, and four Botox injections. The 37 (56.06%) remaining patients did not require any other surgery after closure of vesicostomy. CONCLUSION: Vesicostomy should be considered in children with neuropathic bladder or bladder outlet obstruction in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections, protect the upper urinary tract, and reduce the need for a major surgery without decreasing the bladder capacity.
Subject(s)
Cystostomy/methods , Rest , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/surgery , Urination Disorders/surgery , Vesico-Ureteral Reflux/surgery , Age Factors , Child, Preschool , Cohort Studies , Cystostomy/adverse effects , Female , Follow-Up Studies , Humans , Hydronephrosis/etiology , Hydronephrosis/prevention & control , Infant , Male , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Retrospective Studies , Risk Assessment , Statistics, Nonparametric , Time Factors , Treatment Outcome , Urination Disorders/etiology , Urodynamics/physiology , Urography/methods , Urologic Surgical Procedures/methods , Vesico-Ureteral Reflux/diagnostic imaging , Vesico-Ureteral Reflux/etiologyABSTRACT
OBJECTIVES: To report the long-term outcome of tension-free vaginal tape (TVT) and pubovaginal sling (PVS) in the treatment of stress urinary incontinence (SUI) in female patients. MATERIALS AND METHODS: The long-term objective and subjective results of female patients who were previously randomized in a single blind study to two arms, TVT or PVS, between 2000 and 2004, were evaluated. The patients were asked if they were satisfied with the results of the procedure and if they would recommend it to a friend or relative. The assessment included a physical examination and cough-induced stress test. Satisfaction levels were assessed by Likert-type scale. Cure was described as absence of urine leakage in any circumstances, while improvement was characterized as subjective improvement of SUI without complete resolution. RESULTS: One hundred women with SUI underwent surgery at the present medical center between 2000 and 2004. A total of 52 patients were followed clinically for objective and subjective assessment. Seventeen were interviewed only by telephone. The objective cure rate was 81.5% and 84%, where as subjective cure rate was 70.3% and 71.9%, for TVT versus PVS, respectively (p > 0.05). After an average follow-up of 10.5 years, there was no difference in clinical outcome, satisfaction scores, and postoperative complications between the two groups. CONCLUSION: Both TVT and PVS are safe and effective treatments for SUI in fe- male patients, with acceptable success rate in long term follow-up.
