151. Fecal and urinary continence after ileal cecal cystoplasty for the neurogenic bladder.
- Author
-
Husmann DA and Cain MP
- Subjects
- Cecum surgery, Child, Female, Follow-Up Studies, Humans, Ileum surgery, Male, Retrospective Studies, Fecal Incontinence etiology, Urinary Bladder surgery, Urinary Bladder, Neurogenic surgery, Urinary Incontinence etiology, Urinary Reservoirs, Continent
- Abstract
Purpose: In patients with a neurogenic bladder augmentation with the ileal cecal segment has generally been disregarded as an option due to concerns regarding fecal incontinence. We report our results using a hemi-Indiana pouch bladder augmentation for neurogenic bladder., Materials and Methods: A review of 63 patients with neurogenic bladder dysfunction treated with a hemi-Indiana pouch bladder augmentation was performed. None of the patients had fecal incontinence before surgery., Results: Median followup interval was 6 years (range 1 to 10). Etiology of the neurogenic bladder was spinal cord injury in 42 patients (66%), myelodysplasia in 18 (29%) and sacral agenesis in 3 (5%). One patient (1.5%) died immediately postoperatively from a pulmonary embolus. Of the remaining 62 patients, urinary continence was achieved in 54 (87%) and 8 were incontinent per the abdominal stoma. All 8 patients were treated with Contigen injections into the stoma and 4 (50%) became continent. The 4 patients with persistent urinary incontinence became continent after open surgical revision. Postoperatively, fecal continence was improved in 14 patients (23%), unchanged in 46 (74%) and worse in 2 (3%). In 2 patients with deterioration in bowel function stool frequency and fecal soilage increased in conjunction with antibiotic usage. No patient had chronic fecal incontinence., Conclusions: In select patients with neurogenic bladder dysfunction ileal cecal bladder augmentation with a continent tapered ileal limb results in a 100% incidence of urinary continence with minimal alterations in fecal continence.
- Published
- 2001