Archive ouverte HAL - Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans

Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans

Abstract : NTRODUCTION: This study analyzed long-term functional outcome of continent catheterizable channels with the Mitrofanoff procedure, their continence, complications and the satisfaction of the patients. MATERIAL AND METHOD: Data from patients who underwent a Mitrofanoff procedure at our institution from June 1997 to March 2015 were retrospectively collected. All patients were contacted at the end of the study, a survey was submitted to them. RESULTS: Sixty-seven patients underwent a continent cystostomy with the Mirtrofanoff procedure. Forty-five patients had the inclusion criteria: 18 years old or older, no previous urinary diversion with a minimum of 6 months of follow-up. The cohort comprised mainly neurologic bladder (84 %) with spinal cord injuries (54 %) or spina-bifida patients (15 %). Median age was 35 years old [22-49]. Median follow-up was 64months [39-90]. The surgical procedure used an appendicular channel: 30 patients (67 %) or a continent ileal plasty: 15 patients (33 %). At the end of follow-up: 88 % patients have a full cystostomy continence, 89 % full uretral continence. Twenty-nine patients had one (41 %) or more reinterventions. Reasons for the 58 reinterventions were: stomal stenosis (31 %), uretral incontinence (29 %), cystostomy incontinence (15 %), lithiasis (9 %). Those reinterventions were done with a local surgery (31 %) or an endoscopic surgery (35 %). Overall early adverse events (<30days) or delayed (>30days) adverse events were similar (P=0.93) in appendicovesicostomy group or continent ileal plasty group. Ninety-four percent patients described a satisfactory urinary comfort. The cystostomy was considered esthetic by 71 %, its realization allowed an improvement of the quality of life for 89 % of them. CONCLUSION: Continent channels in adults demonstrate favorable long-term outcomes even if reinterventions could be necessary to maintain a continent and catheterizable channel. Despite reinterventions, patients remain satisfied by the Mitrofanoff procedure which facilitate the process of clean intermittent catheterization.
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https://hal.archives-ouvertes.fr/hal-02180390
Contributeur : Catherine Zoppis <>
Soumis le : jeudi 11 juillet 2019 - 14:20:34
Dernière modification le : lundi 5 août 2019 - 15:33:09

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D. Poncet, B. Boillot, C. Thuillier, J.-L. Descotes, J.-J. Rambeaud, et al.. Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans. Progrès en Urologie, Elsevier Masson, 2019, 29 (3), pp.147-155. ⟨10.1016/j.purol.2018.12.006⟩. ⟨hal-02180390⟩

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