Sb. Eckford et al., LONG-TERM FOLLOW-UP OF TRANSVAGINAL URETHRAL CLOSURE AND SUPRAPUBIC CYSTOSTOMY FOR URINARY-INCONTINENCE IN WOMEN WITH MULTIPLE-SCLEROSIS, British Journal of Urology, 74(3), 1994, pp. 319-321
Objective To assess the long-term success, in terms of continence and
patient satisfaction, of transvaginal urethral closure and suprapubic
cystostomy in women with multiple sclerosis and urinary incontinence.
Patients and methods The group under study comprised 50 severely disab
led women with multiple sclerosis who were undergoing suprapubic cysto
stomy and transvaginal urethral closure to manage urinary incontinence
refractory to conservative measures and urethral catheterization. Fol
low-up was by patient interview and Catheter Change Clinic records. Re
sults An initial continence rate of 78% was achieved and secondary rev
ision was attempted in 10%. Urinary diversion was performed in 4% and
a return to urethral catheterization in 2%. Long-term follow-up (mean
length 6.5 years) showed that 79% of patients remained completely dry
and were managed by regular catheter change. Six per cent of women wit
h continued leakage around the suprapubic site were managed by conserv
ative local methods. The major complications of urethral closure and s
uprapubic cystostomy (recurrent calculi and encrustation blockage) rel
ated to the presence of the catheter. Conclusions The lack of major co
mplications associated with transvaginal urethral closure and suprapub
ic cystostomy, and the high rates of continence and patient satisfacti
on suggest that this technique could be more widely used. Particularly
, it could be employed at an earlier stage in multiple sclerosis and t
hus offer patients a better quality of life for a longer period of tim
e. Modifications in catheter design may overcome problems of calculi a
nd encrustation blockage.