Patient reported outcomes after ileocystoplasty in spinal cord injury population

Sakalis V1, Rachel O2, Philippa C2, Peter G2, Melissa D2

Research Type

Clinical

Abstract Category

Neurourology

Abstract 39
Neurogenic Bladder
Scientific Podium Short Oral Session 4
Wednesday 29th August 2018
11:30 - 11:37
Hall A
Detrusor Overactivity Spinal Cord Injury Voiding Dysfunction
1. General Hospital of Thessaloniki 'Agios Pavlos', Thessaloniki, Greece, 2. Salisbury NHS Trust, Salisbury, UK
Presenter
V

Vasileios Sakalis

Links

Abstract

Hypothesis / aims of study
Ileocystoplasty (IC) is the most popular bladder augmentation procedure. According to the literature, it stabilizes renal function and prevents anatomical deterioration. In the spinal cord injury (SCI) population, it is reserved for those who have failed pharmacotherapy and minimally invasive treatment options such as botulinum toxin injections.
Many symptomatic patients are reluctant to have an IC due to the morbidity associated with the procedure.  Ancedotally, multiple consultations are often required prior to a patient consenting for this procedure.   The aim of this study was to assess the outcomes of IC from the patient’s perspective.
Study design, materials and methods
A retrospective survey was conducted of SCI patients who underwent IC from 2009 to 2014 in our unit.  The Qualiveen questionnaire was utilised, which has been validated for neurogenic bladder dysfunction. To avoid recall bias, 10 randomly selected SCI who were due for IC served as controls. 
The primary end point was the change in total Qualiveen score. The secondary outcomes were the changes in the Qualiveen domains, quality of life score and the degree of satisfaction in a scale from 0-10. Pearson test was used for correlations and t-test to assess intra group variability.
Results
The questionnaire was posted to 45 patients and 37 completed it. There was a strong correlation among the pre-operation scores and control scores (r=0.894). The mean difference in total Qualiveen score was -21.1 (p<0.001). The mean difference in bother domain was -1.43 (p<0.001), in restrictions domain +0.5 (p=0.03), in forced domain +0.98 (p=0.002), in worries domain -1.09 (p=0.01) and in feel domain -1.16 (p<0.001). Quality of life was improved in 89.2% of patients. At average, each candidate required 10.9 (0-36) months to decide and consent. The degree of satisfaction was 7.83 (0-10). The average recovery time and return to preoperative activities, was reported to 5.1 (1-19) months. 
The most frequent reported complication was urinary tract infections and bladder stones that require 1.2 admissions per year per patient
Interpretation of results
The results show that there is high degree of satisfaction, as evidenced from the Qualiveen scores, and all domains were significantly improved. In addition, average recovery time and return to preoperative activities is within acceptable limits. The complications can be minimized by diet modification and regular bladder wash outs.
Concluding message
Clam ileocystoplasty remain the cornerstone in managing difficult, poorly compliant bladders in spinal cord individuals. During consultation, the surgeon should inform the potential candidates for the degree of satisfaction, the post- operative complications and the timing regarding the return to normal activities.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee local committee Helsinki Yes Informed Consent Yes