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Pages: 97-100
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How to manage a dysfunction of the efferent segment in continent cutaneous urinary diversion (hydraulic reservoir)?
A retrospective study of 10 cases

Author: F. Khalil, A. Barki, H. El Sayegh, A. Iken, L. Benslimane, Y. Nouini

Category: JMSR Surgery


Continent cutaneous reservoirs after cystectomy remain an invaluable treatment option for a well-defined subset of indications. The continence mechanism largely determines the treatment success in terms of patient satisfaction and quality of life. Any dysfunction is considered a failure by both patients and surgeons.
A retrospective study was made from 2003 to 2013 (13 years) with the aim to characterize the hydraulic valve dysfunction in patients who underwent a cystectomy with continent urinary pouch. A total of ten patients were included in this study.
The main age was 44 years. The indications of cystectomy were pelvic tumors (62%), vesico-vaginal fistulas (20%), bladder extrophy (10%), hypospadias (4%) and complicated uretral strictures (4%). An hydraulic continent valve according the Benchekroun process was made for all our patients. After a median follow-up of 36 months, the main related efferent segment complications were fistulas in the top of the valve or "pinhole fistula" in 25% of cases, the externalized prolapse of disinserted valve in 25% of cases, and the progressive desinvagination with urinary incontinence in 50% of cases
Continent catheterizable urinary diversion remains a treatment option for a well-defined subset of indications. There is little consensus regarding the different options for the efferent segment, which has the greatest influence on patient satisfaction.

Keywords: Continent urinary diversion, efferent segment, hydraulic valve