Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction

Abstract

The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction.

Long-term response of different Botulinum toxins in refractory neurogenic detrusor overactivity due to spinal cord injury

“…In our sample, a high percentage of SCI patients (70.7%) has been in follow-up for longer than 15 years. Seventeen out 60 patients (12 of whom were CF) asked for bladder augmentation ( 24 , 25 ).…”

Correlation of ultrasound bladder vibrometry assessment of bladder compliance with urodynamic study results

“…In case of neurological defects such as spinal cord injuries, excessive growth of the bladder fibrotic tissue can increase its rigidity, which in turn can lead to a noncompliant bladder [ 6 ]. The changes on the bladder’s mechanical properties occur gradually over the course of several months [ 7 ]; therefore, patients in risk of developing bladder non-compliance are routinely examined to detect these changes in an early stage and avoid the progression by prescribing appropriate medication.…”

Aggressive Bladder Tumour Following Clam Ileocystoplasty: A Rare Long-Term Complication

“…The procedure can be fraught with troublesome complications, including recurrent urinary tract infections, excessive mucus production, and frequent plugging, which can occur relatively early post-op and persist throughout life. The most serious and life-threatening complication is the rare but real risk of malignant transformation in the area of anastomosis [ 8 , 11 ], which unfortunately led to the demise of the index patient. The tumour was metastatic at presentation, consistent with literature reports [ 5 , 6 ].…”

“…Clam ileocystoplasty, like other bladder augmentation procedures, has been shown to satisfactorily treat refractory detrusor overactivity. However, it can be associated with a variety of complications, including excessive mucus production, the need for regular clean intermittent self-catheterization (CISC), recurrent urinary tract infections (UTI), bladder stones, and late long-term metabolic and bowel-related problems [ 3 , 8 , 9 , 11 ].…”

“…In the mid-20th century, it was widely carried out to treat the long-term complication of tuberculous cystitis; a small, contracted and unstable bladder [5,6]. More recently, it is mainly indicated in severe refractory OAB, especially of neurogenic origin [7][8][9][10][11].…”