ILEOVESICOSTOMY AS AN ALTERNATIVE FORM OF BLADDER MANAGEMENT IN TETRAPLEGIC PATIENTS

Objectives. Bladder management in tetraplegic patients traditionally h as been intermittent catheterization by a caretaker, placement of indw elling suprapubic or urethral catheters, sphincterotomy and external c atheter drainage, or supravesical urinary diversion with an ileal cond uit. The aim of this study was to examine the ileovesicostomy as an al ternative form of bladder management in such patients. Methods. We rep ort our experience with ileovesicostomy as an incontinent cutaneous ur inary diversion not requiring ureteral reimplantation. Six tetraplegic patients who had experienced significant morbidity with their preoper ative form of bladder management were managed with an ileovesicostomy fashioned like a funnel from the bladder dome to the right lower quadr ant. All patients underwent preoperative and postoperative fluoroscopi c and urodynamic evaluations. Patients were evaluated preoperatively a nd followed postoperatively with serum chemistries, upper urinary trac t imaging, and urine bacteriologic studies. Results. There were no per ioperative complications. Postoperative urodynamics demonstrated subje cts to have a mean stomal leak-point pressure of 7.7 cm H2O (range 5 t o 10). Radiographically, patients carried low urinary residuals (less than 100 cc) and did not exhibit vesicoureteral reflux. In follow-up o f 12 to 15 months, no patient has demonstrated calculus formation, hyd ronephrosis, autonomic dysreflexia, or worsening renal function. Concl usions. This procedure successfully creates continuous urinary drainag e without catheterization, while maintaining the native antireflux mec hanism of the ureterovesical junction and avoiding indwelling foreign materials in the urinary tract. Longer follow-up with more cases will be necessary to confirm these findings and to support a recommendation of the incontinent ileovesicostomy as a standard method for managing the neurogenic bladder in tetraplegic patients. (C) 1997, Elsevier Sci ence Inc.