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The use of urodynamic to assess the mechanism of incontinence in patients with Yang-Monti based catheterizable cutaneous stomas

Authors :
M. Abdelwadood
Eman H. Ibrahim
Tamer A. Abouelgreed
Yasser M. Haggag
Mohamed M. Yassin
Mohamed A. Elhelaly
El-Sayed I. El-Agamy
Basem Fathi
Salma F. Abdelkader
Sameh S. Ali
Naglaa M. Aboelsoud
Nasser Ramadan
Mohamed Sobhy
Tarek Gharib
Source :
Archivio Italiano di Urologia e Andrologia (2024)
Publication Year :
2024
Publisher :
PAGEPress Publications, 2024.

Abstract

Objective: To analyze the static and dynamic urodynamic parameters of reservoirs and continent conduits in continent cutaneous urinary diversion with catheterizable stoma. Materials and methods: 76 patients had augmented ileocystoplasty or continent urinary diversion with catheterizable urinary stoma based on Mitrofanoff principle and Yang-Monti procedure using subserous tunnel as continence mechanism. They were followed up for at least 6 months post-operatively for continence through stoma and divided into two groups (continents vs non-continent) according to stomal continence. Both groups had urodynamic assessment performed via the stoma to assess reservoir capacity, pressure and contractions, efferent limb functional length, reservoir overactivity, static and dynamic maximal closure pressures and leak point pressure. Results: Continence rate was 87%. Continent group included 66 patients and incontinent group included 10 patients. In both groups at rest, the reservoir pressure after filling did not exceed 25 cm H2O. During peristaltic contraction, the pressure did not exceed 30 cm H2O and the duct remained continent. After Valsalva maneuver, the reservoir pressure increased up to 34 (+ 7.4) cm H2O and leakage occur in 10 patients (13%). Reservoir (wall) overactivity was recorded in 54 patients, with insignificant rise in intraluminal pressure during the contractions. In both groups, the efferent tract closing pressure was always higher than the reservoir pressure. The mean of maximal closing pressure at Valsalva was 82.5 (+ 4.18) cm H2O in the continent group and 61.66 (+ 8.16) cm H2O in the incontinent group. The mean functional length of the conduit was 4.95 + 1.62 in the continent group and 2.80 + 1.50 cm in the incontinent group. Conclusions: Urodynamic evaluation of continent catheterizable cutaneous stoma after Yang-Monti procedure has a practical significance. Functional length of the conduit seems to be the most influential factor for continence reflecting static & dynamic maximal closure pressure. Higher conduit closing pressure is associated with better continence. Contractions of the pouch and peristaltic contraction of the conduit has no effect on continence mechanism.

Details

Language :
English
ISSN :
11243562 and 22824197
Database :
Directory of Open Access Journals
Journal :
Archivio Italiano di Urologia e Andrologia
Publication Type :
Academic Journal
Accession number :
edsdoj.6e55ad03d5c44fc8bf0f81c667bbae5d
Document Type :
article
Full Text :
https://doi.org/10.4081/aiua.2024.12395