Continent catheterizable vesicostomy in an adult population: success at high costs.

AIMS: To evaluate the long term outcome, to review the complication ratio and to analyze predicting factors of catheterizable continent vesicostomy in an adult population. To deduct a proper patient counseling policy.

METHODS: We identified all patients that underwent a continent vesicostomy between 1998 and 2008. We did not consider patients that underwent orthotopic bladder reconstruction. Patient satisfaction, urinary leakage, catheterization problems were assessed by chart review or interview. Type of primary surgery, revisions (number and type), renal function and complications were assessed by chart review.

RESULTS: Thirty-four patients underwent continent vesicostomy using an ileal segment (Monti or Spiral-Monti/Casale technique) or the appendix (Mitrofanoff). One patient underwent a detrusor wall flap. Twenty-one out of 35 patients underwent concomitant bladder augmentation and 2/35 patients bladder neck closure. Mean age at the time of the procedure was 44 years (range 21-80 years). Mean follow up is 60 months (range 6-117 months). Six out of 35 patients undergo surgical excision of the conduit because of untreatable problems. One patient has a permanent indwelling catheter. Two patients voided normal after sacral nerve stimulation. Ten out of 35 patients undergo stoma related revisions. Sixteen out of 35 patients undergo no stoma related revisions. Finally 26/35 patients were continent and had an easy catheterizable stoma.

CONCLUSIONS: Continent urinary diversion in an adult population is associated with a high complication and revision rate. Although conversion rate to an ileal conduit is appreciable, the majority of patients (26/35) finally achieve full continence and unobstructed access to the bladder.