IMPROVED QUALITY-OF-LIFE AND SEXUALITY WITH CONTINENT URINARY-DIVERSION IN QUADRIPLEGIC WOMEN WITH UMBILICAL STOMA

Quality of life issues prompted us to offer continent urinary diversio n to quadriplegic women who required cystectomy for end-stage neurogen ic vesical dysfunction complicated by urethral destruction as a result of chronic indwelling catheterization. Three women with spinal cord i njury (SCI) and resultant quadriplegia of 5 to 15 years duration under went continent urinary diversion. Preoperative evaluation and urodynam ic studies in each showed a bladder capacity of less than 150mL, bilat eral vesicoureteral reflux, recurrent febrile urinary tract infections , an incompetent urethral sphincter, and incontinence around an indwel ling catheter in all three patients. Although highly motivated, these women showed minimal dexterity and were unable to perform urethral sel f-catheterization. Each was opposed to having an incontinent abdominal urinary stoma. The urinary reservoir was created from 30cm of detubul arized right colon. The continence mechanism used an intussuscepted an d imbricated ileocecal valve. The umbilicus was chosen as the urostomy site because of cosmetic appearance and ease of catheterization for a patient with minimal dexterity. Follow-up ranged from 18 to 30 months . Reservoir capacity ranged from 550 to 800mL without evidence of refl ux or stomal leakage. The incidence of symptomatic autonomic dysreflex ia and urinary tract infection decreased postoperatively in all patien ts. Of the two women who were sexually active, the frequency of activi ty increased from 8 to 15 episodes per month in one and 3 to 4 episode s per month in the other. Both reported improved sexual enjoyment. Bod y image and satisfaction with urologic management increased in all thr ee patients. In conclusion, continent urinary diversion in selected qu adriplegic patients is a reasonable alterative to incontinent intestin al urinary diversion. The umbilical stoma provides an excellent cosmet ic result which patients with minimal dexterity are able to catheteriz e easily. Continent urinary diversion in women results in improved sel f-image, quality of life, and enables greater sexual satisfaction. (C) 1994 by the American Congress of Rehabilitation Medicine and the Amer ican Academy of Physical Medicine and Rehabilitation