Management of neurogenic bladder dysfunction with incontinent ileovesicostomy

Objectives. Incontinent ileovesicostomy is an alternative form of urinary m anagement applied to patients with neurogenic vesical dysfunction who are e ither unable or unwilling to perform clean intermittent self-catheterizatio n or assisted catheterization. We review our operative results, urodynamic data, and complications observed in patients who underwent creation of inco ntinent ileovesicostomy at our institution. Methods. Thirteen patients (mean age 43.2 years) with neurogenic bladder dy sfunction underwent an incontinent ileovesicostomy between 1994 and 1998. T he etiologies of the neurogenic bladder dysfunction were spinal cord injury in 8 patients, multiple sclerosis in 4 patients, and tuberculous meningiti s in 1 patient. The preoperative data, surgical records, urodynamic finding s, and postoperative complications were assessed. Results. All patients experienced complications of their pretreatment bladd er management. The mean operating room time was 242 minutes (range 170 to 3 95), including 14 additional procedures in 1 1 patients. The mean estimated blood loss was 403.8 mt (range 50 to 2000). No patient required blood tran sfusion. There were no intraoperative complications. Only 1 patient require d reoperation for stomal revision. One patient had a ureteral stone 2 years after surgery; 1 patient has continued to have urinary tract infections de spite a negative workup. The mean follow-up was 23 months (range 6 to 57). The mean bladder leak point pressure through the stoma was 8.2 cm H2O. Conclusions. The incontinent ileovesicostomy is a useful technique in the t reatment of patients with neurogenic bladder unable to perform clean interm ittent catheterization. It provides patients with a low-pressure urinary co nduit that empties readily without an indwelling catheter. (C) 1999, Elsevi er Science Inc.