[Continent urinary diversion in neurogenic bladders]. / Dérivation vésicale continente dans les vessies neurologiques.

Many patients with urinary incontinence due to neurogenic sphincter insufficiency are treated by intermittent catheterization combined with drug therapy. A few refractory cases require surgical treatment. The authors report 5 cases of neurogenic bladder in 3 men and 2 women with a mean age of 20 years. The neurological lesion was secondary to spina bifida (2 cases), spinal cord trauma (2 cases) and leprosy (1 case). All patients complained of urinary incontinence due to sphincter atonia, with normal bladder compliance. We opted for continent cystostomy using the Benchekroun hydraulic valve. One death occurred during the postoperative period as a result of an anaesthetic accident. Reopening of the bladder neck occurred in 3 patients and required revision and one patient developed bladder stones 6 years after the operation. The functional results were considered to be excellent. Continent cystostomy using Benchekroun!! technique appears to be a reliable method in the treatment of urinary incontinence due to sphincter incompetence in selected patients.

[Detubularized U-shaped enterocystoplasty after cystoprostatectomy]. / Entérocystoplastie détubulée en U après cystoprostatectomie.

We reviewed the charts of 58 patients who underwent orthotopic bladder replacement after total cystoprostatectomy for muscle invasive bladder cancer. Mean age was 56 years. As described by Camey, 60 centimetres of small bowel, are isolated, detubularised then folded upon itself to form a U shaped reservoir, which is anastomosed to the urethra. Death occurred in 5%. Urologic complications observed were: urinary leakage (15%), ureteral reflux (6.8%), ureteral stenosis (8.6%) and stones of the neobladder (5.1%). 64.2% of the patients were immediately continent during the day. Nocturnal continence was obtained for 50% immediately and for 80% three months postoperatively. Detubularised and U shaped cystoplasty achieve a low pressure reservoir, with protection of the upper urinary tract, and a diurnal continence. Nocturnal continence is achieved later.

Continent urinary diversion using a Modified Indiana Pouch in elderly patients.

A total of 25 patients at least 75 years old underwent continent urinary diversion via a modified Indiana Pouch during a 68-month period, 21 of these with simultaneous radical cystectomy or anterior exenteration. The preoperative medical conditions as well as the early and late operative morbidity and mortality are reviewed with a mean follow up of 27 months. Average age of patients was 78.5 years, and the mean age of survivors is 81 years. There were two early mortalities attributed to ileal gangrene with secondary sepsis and aspiration pneumonia. Postoperative complications (superficial wound infection, middle colic vein bleed, right ureteral leak, ileus) occurred in five patients, two of whom required re-operation. Mean hospital stay was 12.4 days and ranged from 9-20. There were only six late complications [ureteral stricture (3), small bowel obstruction (1), incontinence (1)] necessitating re-hospitalization and surgical intervention. Late infectious complications included recurrent urinary tract infections (3), pyelonephritis (2), and C. Difficile enterocolitis (2) all managed medically. In addition, 10 other patients have died, 9 from metastatic disease and 1 from intercurrent medical problems. Of the 13 remaining patients, 11 are disease free and all are continent with a mean follow-up time of 33 months. We conclude that continent urinary diversion via a modified Indiana pouch with radical cystectomy or anterior exenteration can be performed with minimal morbidity or mortality, even in an elderly population.