LONG-TERM FOLLOW-UP OF TRANSVAGINAL URETHRAL CLOSURE AND SUPRAPUBIC CYSTOSTOMY FOR URINARY-INCONTINENCE IN WOMEN WITH MULTIPLE-SCLEROSIS

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.