Urinary diversion/reconstruction for cases of catheter intolerant secondary progressive XXXX with refractory urinary symptoms.

@entity1 @entity322 @entity6 @entity190 @entity16 @entity2507 @entity15 @entity293
PURPOSE: We assessed surgical outcomes for @entity1 intolerant of catheters with secondary progressive @entity15 undergoing urinary diversion/reconstruction for refractory urinary symptoms. MATERIALS AND METHODS: @entity1 with secondary progressive @entity15 treated with ileovesicostomy, enterocystoplasty and ileal loop surgeries were reviewed for demographic, operative and postoperative data. All @entity1 had attempted maximal conservative therapy, including catheterization options. Evaluated outcome measures included incidence of postoperative @entity322 , @entity293 and Clavien grade 3 or higher complications. RESULTS: A total of 26 @entity1 (22 female) with secondary progressive @entity15 underwent 15 ileovesicostomy, 7 enterocystoplasty and 4 ileal loop procedures. All @entity1 had significant @entity16 (mean Expanded Disability Status Scale 7), and the most common indications for surgery were chronic @entity293 (77%) and refractory @entity322 (77%). Maximum preoperative bladder capacity was 185 cc and mean bladder compliance was 5.7 cc/cm @entity2507 . After a mean followup of 16 months 63% of @entity1 were continent (p = 0.01) and 58% had no further @entity293 (p = 0.03). The type of diversion/reconstruction was not associated with significantly improved continence or @entity293 reduction. No new upper tract changes developed in any @entity1 . There were 11 high grade complications, and @entity1 with a preoperative indwelling catheter (HR 5.89, p = 0.024), @entity6 (HR 5.60, p = 0.009) and increasing @entity190 during surgery (HR 1.09, p = 0.014) were at greatest risk for significant complications. CONCLUSIONS: @entity1 with secondary progressive @entity15 treated with urinary diversion/reconstruction who cannot tolerate catheters had improved continence and fewer @entity293 . However, @entity1 with secondary progressive @entity15 with preoperative indwelling catheters, @entity6 , increased body mass index and increasing operative @entity190 were at greatest risk for postoperative morbidity.
