NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Improved Continence Rates after Rectus Muscle Transposition in Catheterizable Colonic Urinary Reservoirs: Preliminary Results and Report of a Technique
M. Grey Maher, MD1, Arthur Mourtzinos, MD2, Larissa V. Rodriguez, MD3, Shlomo Raz, MD3
1The Urology Center, New Haven, CT, USA, 2The Lahey Clinic, Burlington, MA, USA, 3UCLA, Los Angeles, CA,

Background: Catheterizable urinary reservoirs revolutionized the management of bladder reconstruction. However, urinary incontinence can occur at rates of 3-17%. Quality of life is decreased in patients who leak between catheterizations. We present a case series of 12 patients in whom transposition of the rectus muscle, in a figure of eight formation, at the site of ileal stomal pull through, provided improved continence in both revision and primary cases.
Methods: A total of 12 patients 34 to 79 years old (mean age 48) underwent either revision for incontinence of their catheterizable stoma(4), or primary procedure for urinary diversion (8) at our institutions between October 2005 and February 2006. The indications for lower urinary tract reconstruction in this patient population included malignancy (4), neurogenic bladder (2), interstitial cystitis (3) and urethral dysfunction (3). The continence mechanism is provided by the ileocecal valve, with tapering of the distal ileal segment with absorbable staples, securing the catheterizable ileal segment to the serosa of the cecum along an opened taenia, and prior to transferring the ileal segment through the abdominal wall, it is passed through two halves of the rectus muscle which are transposed to create a figure of eight configuration. Post-operative follow-up includes a pouch pressure-volume study and excretory urogram, flexible cystoscopy and electrolytes beginning at the 3-month postoperative visit.
Results: All 12 patients are female. All urinary reservoirs utilized an ileal-cecal bowel segment. All revision patients had significant pre-operative leakage per stoma. Revisions were performed as inpatient surgery with a mean hospitalization of 1 day. The new urinary diversion patients underwent cystectomy and continent catheterizable stoma with a mean hospital stay of 7days. One revision patient suffered cellulitis near the incision site, two new diversion patients had post-op ileus, and one patient had initial, transient difficulty catheterizing. All 12 patients (100%) are currently dry with a mean follow-up of 6 months. No patients have had traumatic catheterizations, stomal stenosis, peristomal hernia, or long-term difficulty catheterizing.
Conclusions: Our initial experience with the rectus muscle transposition for stomal incontinence, or for primary stomal creation is encouraging. The technique for construction of the additional continence mechanism is straight forward, reliable, and without excess morbidity. We believe that this approach is warranted in the management of urinary incontinence of catheterizable stomas to restore the patient’s quality of life. In addition, this technique is an excellent additional step toward achieving continence in primary urinary diversion cases.


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