ICS 2018: Neuro-Urology: Is There Still a Place for Bladder Augmentation and Urinary Diversion?

Philadelphia, PA (UroToday.com) Intradetrusor onabotulinumtoxinA injections have revolutionized the treatment of refractory neurogenic detrusor overactivity. As a consequence, bladder augmentation and urinary diversion for neuro-urological indications have almost disappeared from the operating theatres and many urologists will no longer be confronted with patients undergoing such reconstructive procedures for refractory neurogenic lower urinary tract dysfunction (NLUTD) during their careers. Bywater and team assessed if there is still a place for bladder augmentation and urinary diversion in modern neuro-urology.

There was a total of 51, a total of 51 patients underwent bladder augmentation from January 2011 and October 2017 (n=12) or urinary diversion (ileal conduit: n=31, continent catheterisable reservoir, n=8) for NLUTD.

Of the 51 patients, mean age was 47 years (standard deviation ±16 years) and 25 (49%) were women. 20 patients suffered from spinal cord injury, 14 from multiple sclerosis, 8 from spina bifida, and 9 from other neurological disorders. Before bladder augmentation, patients were treated with 2 to 3 different antimuscarinics and with 2 to 16 intradetrusor onabotulinumtoxinA injection cycles. All patients with urinary diversion underwent cystectomy. Reasons for ileal conduit and decisions against continent catheterisable reservoir were severely impaired hand (n=18) or cognitive (n=8) function making intermittent self-catheterization impossible, renal failure in 3 and patients’ preference in 2 patients.

Despite the triumphal era of onabotulinumtoxinA treatment in neuro-urology, there is still a place for bladder augmentation and urinary diversion in very selected patients with refractory NLUTD. Thus, meticulous knowledge transfer to upcoming neuro-urologists is of utmost importance to guarantee optimal treatment for prospective neuro-urological patients.

Presented by: Mirjam Bywater, Department of Neuro Urology, Balgrist University Hospital, University of Zürich, Zürich
Co-Authors; Fröhlich M², Eberli D², Kessler T M¹
1. Department of Neuro Urology, Balgrist University Hospital, University of Zürich, Zürich, 2. Department of Urology, University Hospital of Zürich, University of Zürich, Zürich

Written by: Bilal Farhan, MD; Clinical Instructor, Female Pelvic Medicine and Reconstructive Surgery, University of California, Irvine Medical Center, Twitter: @Bilalfarhan79 at the 2018 ICS International Continence Society Meeting - August 28 - 31, 2018 – Philadelphia, PA USA

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