The Argument for Ileal Conduit for the Poorly Compliant Bladder in the Neurogenic Lower Urinary Tract Dysfunction Patient Refractory to Minimally Invasive Treatment.

AIMS: To describe why ileal conduit is the best option for the poorly compliant bladder in the neurogenic lower urinary tract dysfunction patient refractory to minimally invasive treatment.

METHODS: Evidence from prior studies evaluating this patient population were reviewed.

RESULTS: There are few options that can address the urinary incontinence that often accompanies this scenario while also eliminating the elevated storage pressures placing the patients' renal function at risk. Once less invasive options such as oral therapy and intradetrusor high-dose botulinum toxin have failed then surgical options should be considered. Construction of an ileal conduit removes the concern for elevated bladder pressures negatively impacting future renal function, is easy to care for without the need for intermittent catheterization and has demonstrated improved quality of life in patients with neurogenic lower urinary tract dysfunction. In addition, an ileal conduit does not have some of the risks that can be seen with bladder augmentation (with or without continent urinary stoma construction) such as the need for lifelong mucus irrigation, bladder stones, bladder cancer and the need for surgical revision related to the stoma.

CONCLUSIONS: Construction of an ileal conduit is an excellent option for the poorly compliant bladder in the neurogenic lower urinary tract dysfunction patient refractory to minimally invasive treatment. Patient satisfaction rates are high and the risk of damage to the upper urinary tracts are minimized with acceptable short- and long-term morbidity.