Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10-year period: A Neurogenic Bladder Research Group study

AIMS: Evidence is sparse on the long-term outcomes of continent cutaneous ileocecocystoplasty (CCIC). We hypothesized that obesity, laparoscopic/robotic approach, and concomitant surgeries would affect morbidity after CCIC and aimed to evaluate the outcomes of CCIC in adults in a multicenter contemporary study. METHODS: We retrospectively reviewed the charts of adult patients from sites in the Neurogenic Bladder Research Group undergoing CCIC (2007-2017) who had at least 6 months of follow-up. We evaluated patient demographics, surgical details, 90-day complications, and follow-up surgeries. the Mann-Whitney U test was used to compare continuous variables and χ² and Fisher\u27s Exact tests were used to compare categorical variables. RESULTS: We included 114 patients with a median age of 41 years. The median postoperative length of stay was 8 days. At 3 months postoperatively, major complications occurred in 18 (15.8%), and 24 patients (21.1%) were readmitted. During a median follow-up of 40 months, 48 patients (42.1%) underwent 80 additional related surgeries. Twenty-three patients (20.2%) underwent at least one channel revision, most often due to obstruction (15, 13.2%) or incontinence (4, 3.5%). Of the channel revisions, 10 (8.8%) were major and 14 (12.3%) were minor. Eleven patients (9.6%) abandoned the catheterizable channel during the follow-up period. Obesity and laparoscopic/robotic surgical approach did not affect outcomes, though concomitant surgery was associated with a higher rate of follow-up surgeries. CONCLUSIONS: In this contemporary multicenter series evaluating CCIC, we found that the short-term major complication rate was low, but many patients require follow-up surgeries, mostly related to the catheterizable channel

Comparison of Urinary Tract Infection Incidence Following Intradetrusor OnabotulinumtoxinA in Office Versus Operating Room Settings

IMPORTANCE: Urinary tract infection (UTI) is a known complication of intradetrusor onabotulinumtoxinA (BTX) injection. However, whether administering intradetrusor BTX in different clinical settings affects the risk of postprocedural UTI has not been investigated. OBJECTIVES: The objective of this study was to assess differences in the incidence of postprocedural UTI in women who received intradetrusor BTX in an outpatient office versus an operating room (OR). STUDY DESIGN: We performed a retrospective chart review of intradetrusor BTX procedures at a single institution between 2013 and 2020. Demographic data, comorbidities, and perioperative data were abstracted. The primary outcome was UTI defined as initiation of antibiotics within 30 days following BTX administration based on clinician assessment of symptoms and/or urine culture results. Univariate analysis of patients with and without UTI was performed. RESULTS: A total of 446 intradetrusor BTX procedures performed on female patients either in an outpatient office (n = 160 [35.9%]) or in an OR (n = 286 [64.1%]) were included in the analysis. Within 30 days of BTX administration, UTI was diagnosed after 14 BTX procedures (8.8%) in the office group and 29 BTX procedures (10.1%) in the OR group ( P = 0.633). De novo postprocedural urinary retention occurred in more women who were treated in the office than in the OR (13 [9.6%] vs 3 [1.3%], P \u3c 0.001). CONCLUSIONS: Selecting the appropriate setting for BTX administration is dependent on multiple factors. However, the clinical setting in which intradetrusor BTX is administered may not be an important factor in the development of postprocedural UTI, and further research is warranted

Lower urinary tract symptoms in women with spinal pathologies: a prospective prevalence study

Introduction: The relationship between spinal pathologies and lower urinary tract symptoms (LUTS) is largely unknown. The incidence of LUTS in patients with lumbar disk disease has been estimated to be between 27% and 92%. Further, the effect of spine surgery on lower urinary tract symptoms has not been definitively established. The objective of this study was to determine the prevalence of urinary dysfunction among female patients with spinal pathologies and to evaluate the effects of spinal surgery on these symptoms using validated questionnaires. Methods: After IRB approval, women with lower spine complaints were identified in the neurosurgery clinic. Patients were asked to fill out the Pelvic Floor Distress Inventory (PFDI‐20) and Pelvic Floor Impact Questionnaire (PFIQ‐7) at their initial visit. Exclusion criteria included primary spinal pathology in the cervical spine. If the patient elected to undergo spine surgery after their initial evaluation, questionnaires were obtained at 6 weeks and 6 months postoperatively. Patient demographics, medical and surgical history were obtained through a review of the electronic medical record. Results: A total of 169 patients were recruited between April 2017 and July 2019. See Table 1. At baseline, 72.7% answered “yes” to at least one question on the Urinary Distress Inventory (UDI‐6). The average score was 23.5/100. Those with higher UDI‐6 scores were strongly correlated to higher Urinary Impact Questionnaire (UIQ‐7) score (Pearson correlation coefficient= 0.69). Colorectal‐Anal Distress Inventory (CRADI‐8) was also evaluated with 64.3% presenting with some level of bowel complaints. The average score was only 14.4/100. Higher baseline UDI‐6 and CRADI‐8 scores were observed for patients with a history of a prior hysterectomy, use of stool softeners, and a spinal pathology including L3 (P \u3c 0.05). Postoperative questionnaires were obtained from 22 women at 6 weeks and 8 women at 6 months, with the average UDI‐6 scores being 19.9/100 and 31.2/100, respectively. Conclusion: Though the majority of women presented with some level of urinary bother, quality of life impact appeared low. More significant bother was seen in patients that had L3 spinal involvement at their initial assessment. At this point, there was no demonstrable influence of surgery on urinary symptoms, though the number of patients followed postoperatively was small