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Strictures in the Ileal Portion of Ileocecal Conduits in Children and Young Adults
1126
1
URINARY DYSFUNCTION IN TRANSVERSE i1YELITIS.
Yitzhak Berger*) New York, NY. (Presentation to be made by Dr. Berger.) Transverse myelitis is a rare inflammatory condition, usually of viral etiology, involving tl1e whole thickness of the spinal cord. Neurogenic bladder is common) yet no prior neurourological studies have been published. Herein we report our experience with six men and one woman (ages 21 - 51 years) who experienced tranverse myelitis for 2 months to 13 years previously. Follow-up ranged from 6 months to 4 years. All patients had made almost complete neurologic recoveries except for persistent genitourinary symptoms. Five patients initially had urinary retention~ two had frequency urgency and urge in~ontinence. Two men had erectile impotence, one had ejaculatory and orgasmic impotence~ despite normal erections. Three patients had clinical evidence of sacral neurologic abnormalities. IVP was normal in all. Six patients underwent video/urodynamics; all had detrusor-external sphincter dyssynergia (DESO). One initially had an acontractile bladder, but, subsequently developed DESO. Four patients are treated with anti-cholinergics and self intermittent catheterization. Two preferred no treatment but have persistent urinary frequency and urgency with rare incontinence and one was lost to follow-up. No patient had any urologic improvement. We conclude that neurogenic bladder and male sexual dysfunction can persist long after an otherwise complete neurologic recovery. Accordingly~ interval urologic follow-up is mandatory as long as evidence for bladder dysfunction persists.
STRICTURES IN THE HEAL PORTION OF ILEOCECAL CONDUITS IN CHILDREN AND YOUNG ADULTS. Charles E. Horton Jr*., Robert L. Lebowitz, Alan B. Retik and James Mandell, Eoston, MA. ( Presentation to be made by Dr. Horton) Urinary diversion is now used infrequently in children and young adults. fbwever, there are still rare circumstances when diversion may be the best primary treatment option. Al so, there are some patients who were previously diverted and are not candidates for und iversion. A well known late complication of ileal conduits is develoµnent of strictures in the loop, with subsequent upper tract deterioration. This report concerns the occurence of strictures in the ileal portion of ileocecal conduits in patients who have undergone a change in the type of diversion from ileal to ileocecal loop. Ileocecal cutaneous diversion was first described by Zirruan and Libertino in 1975. It offers advantages of a colonic stoma, an antireflux mechanian, plus good mobility of the bowel segment and a dependable blood supply. However, the ileocecal conduit, 1 ike the ileal conduit, is at risk for developnent of stenoses. Therefore patients that have developed stricture of an ileal loop probably should be converted to a sigmoid conduit rather than an ileocecal conduit, as they have previously exhibited a tendency toward ileal stenos is. Because these strictures develop slowly, there are often no symptoms. Therefore ongoing periodic upper urinary tract screening in patients with ileocecal conduits is mandatory, just as it is in those with ileal loops. This can be done with either intravenous pyelography or ultrasonography. If upper tract dilatation is detected, retrograde loopography should be done with flouroscopic guidance. Drainage films are essential. If the ileocecal valve is competent and there is no reflux, antegrade pyelography may be needed.
1128
1129
LONG TERM EFFECTS OF VESICOSTOMY ON URINARY BLADDER FUNCTION IN PATIENTS WITH POSTERIOR URETHRAL VALVES.
TAPERED DISTAL ILEUM CONSTRUCTION OF A CONTINENT URINARY RESERVOIR. Darwich E. Bejany*, Miami, FL (Presentation to be made by Dr. Bejany.) Creation of a continent colonic urinary reservoir was performed in 6 paitents who have had anterior exenteration for invasive bladder carcinoma. A tapered distal ileal segment with a catheterizable abdominal stoma provided full continence in all 6 patients. A non-tunnelled ureterocolonic anastomosis was performed in all 12 ureters with no obstruction or reflux.
Antoine E. Khoury, Torontoj Ontario~ Canada. (Presentation to be made by Antoine E. Khoury). There is a debate regarding the long term effects of temporary cutaneous vesicostomy on bladder function in patients with posterior urethral valves. Some authors are opposed to its use for fear of ending up with a small capacity and/or low compliance bladder. This report describes the clinical and long term urodynamic results in 10 patients with posterior urethral valves that were managed initially by a temporary cutaneous vesicostomy, Eighty percent of patients were one month, or less, of age at the time of diversion, The duration with vesicostomy ranged from 5-32 months (mean 18 months). Follow-up ranged from 9 months to 7 years (mean 58 months) after closure of the vesicostomy. All patients at that time were evaluated by history~ serum creatinine~ water loading, flow rate and residual to assess functional bladder capacity~ in addition to a full urodynarnic work-·up. Serum creatinine dropped from a mean+ SEM of 220 ± 60 umol/L at presentation to 50 ± 25 umol/L on follow-up. Bladder capacity ranged from the 20th to 90th percentile (average 49th percentile) on the Geist bladder capacity nomograrn. Only 20 percent of patients demonstrated bladder instability on urodynamics, Eighty percent of the patients have satisfactory compliance. This study supports our belief that cutaneous vesicostomy is an excellent form of temporary diversion in patients with posterior urethral valves that are not amenable for primary valve resection.
385A
1
URINARY DYSFUNCTION IN TRANSVERSE i1YELITIS.
Yitzhak Berger*) New York, NY. (Presentation to be made by Dr. Berger.) Transverse myelitis is a rare inflammatory condition, usually of viral etiology, involving tl1e whole thickness of the spinal cord. Neurogenic bladder is common) yet no prior neurourological studies have been published. Herein we report our experience with six men and one woman (ages 21 - 51 years) who experienced tranverse myelitis for 2 months to 13 years previously. Follow-up ranged from 6 months to 4 years. All patients had made almost complete neurologic recoveries except for persistent genitourinary symptoms. Five patients initially had urinary retention~ two had frequency urgency and urge in~ontinence. Two men had erectile impotence, one had ejaculatory and orgasmic impotence~ despite normal erections. Three patients had clinical evidence of sacral neurologic abnormalities. IVP was normal in all. Six patients underwent video/urodynamics; all had detrusor-external sphincter dyssynergia (DESO). One initially had an acontractile bladder, but, subsequently developed DESO. Four patients are treated with anti-cholinergics and self intermittent catheterization. Two preferred no treatment but have persistent urinary frequency and urgency with rare incontinence and one was lost to follow-up. No patient had any urologic improvement. We conclude that neurogenic bladder and male sexual dysfunction can persist long after an otherwise complete neurologic recovery. Accordingly~ interval urologic follow-up is mandatory as long as evidence for bladder dysfunction persists.
STRICTURES IN THE HEAL PORTION OF ILEOCECAL CONDUITS IN CHILDREN AND YOUNG ADULTS. Charles E. Horton Jr*., Robert L. Lebowitz, Alan B. Retik and James Mandell, Eoston, MA. ( Presentation to be made by Dr. Horton) Urinary diversion is now used infrequently in children and young adults. fbwever, there are still rare circumstances when diversion may be the best primary treatment option. Al so, there are some patients who were previously diverted and are not candidates for und iversion. A well known late complication of ileal conduits is develoµnent of strictures in the loop, with subsequent upper tract deterioration. This report concerns the occurence of strictures in the ileal portion of ileocecal conduits in patients who have undergone a change in the type of diversion from ileal to ileocecal loop. Ileocecal cutaneous diversion was first described by Zirruan and Libertino in 1975. It offers advantages of a colonic stoma, an antireflux mechanian, plus good mobility of the bowel segment and a dependable blood supply. However, the ileocecal conduit, 1 ike the ileal conduit, is at risk for developnent of stenoses. Therefore patients that have developed stricture of an ileal loop probably should be converted to a sigmoid conduit rather than an ileocecal conduit, as they have previously exhibited a tendency toward ileal stenos is. Because these strictures develop slowly, there are often no symptoms. Therefore ongoing periodic upper urinary tract screening in patients with ileocecal conduits is mandatory, just as it is in those with ileal loops. This can be done with either intravenous pyelography or ultrasonography. If upper tract dilatation is detected, retrograde loopography should be done with flouroscopic guidance. Drainage films are essential. If the ileocecal valve is competent and there is no reflux, antegrade pyelography may be needed.
1128
1129
LONG TERM EFFECTS OF VESICOSTOMY ON URINARY BLADDER FUNCTION IN PATIENTS WITH POSTERIOR URETHRAL VALVES.
TAPERED DISTAL ILEUM CONSTRUCTION OF A CONTINENT URINARY RESERVOIR. Darwich E. Bejany*, Miami, FL (Presentation to be made by Dr. Bejany.) Creation of a continent colonic urinary reservoir was performed in 6 paitents who have had anterior exenteration for invasive bladder carcinoma. A tapered distal ileal segment with a catheterizable abdominal stoma provided full continence in all 6 patients. A non-tunnelled ureterocolonic anastomosis was performed in all 12 ureters with no obstruction or reflux.
Antoine E. Khoury, Torontoj Ontario~ Canada. (Presentation to be made by Antoine E. Khoury). There is a debate regarding the long term effects of temporary cutaneous vesicostomy on bladder function in patients with posterior urethral valves. Some authors are opposed to its use for fear of ending up with a small capacity and/or low compliance bladder. This report describes the clinical and long term urodynamic results in 10 patients with posterior urethral valves that were managed initially by a temporary cutaneous vesicostomy, Eighty percent of patients were one month, or less, of age at the time of diversion, The duration with vesicostomy ranged from 5-32 months (mean 18 months). Follow-up ranged from 9 months to 7 years (mean 58 months) after closure of the vesicostomy. All patients at that time were evaluated by history~ serum creatinine~ water loading, flow rate and residual to assess functional bladder capacity~ in addition to a full urodynarnic work-·up. Serum creatinine dropped from a mean+ SEM of 220 ± 60 umol/L at presentation to 50 ± 25 umol/L on follow-up. Bladder capacity ranged from the 20th to 90th percentile (average 49th percentile) on the Geist bladder capacity nomograrn. Only 20 percent of patients demonstrated bladder instability on urodynamics, Eighty percent of the patients have satisfactory compliance. This study supports our belief that cutaneous vesicostomy is an excellent form of temporary diversion in patients with posterior urethral valves that are not amenable for primary valve resection.
385A