Cutaneous ileocystostomy (a bladder chimney) for the treatment of severe neurogenic vesical dysfunction
The aim of this study was to investigate the efficacy and morbidity of cutaneous ileocystostomy, as an alternative to cystectomy and ileal conduit urinary diversion, for patients with end-stage neurogenic vesical dysfunction. Three male and eight female patients, mean age 41 years (range 28–59), with a mean duration of a neuropathic bladder of 8 years (range 4–17 years) underwent evaluation for ileocystostomy urinary diversion. Indications for the procedure included a bladder capacity ≤ 200 ml (10 patients), recurrent febrile urinary tract infection (nine patients), and urinary incontinence despite an indwelling urethral catheter (all eight women). Each was felt to be a poor candidate for, or refused, continent urinary diversion or bladder augmentation cystoplasty. All eight females required concomitant pubovaginal sling urethral compression to eliminate urinary leakage from a patulous, non-functional urethra. Two patients required bilateral ureteral reimplantation for grade III-IV/V reflux. Effective low-pressure urinary stomal drainage was achieved without the need for chronic catheterization in all of the patients with a mean duration of follow-up of 24 months (range 6–60 months). No patient has developed pyelonephritis since the procedure. Urethral urinary leakage was eliminated in all of the female patients, whilst vesicoureteral reflux resolved in those with reflux preoperatively.