The use of urodynamic to assess the mechanism of incontinence in patients with Yang-Monti based catheterizable cutaneous stomas

M. Abdelwadood; Eman H. Ibrahim; Tamer A. Abouelgreed; Yasser M. Haggag; Mohamed M. Yassin; Mohamed A. Elhelaly; El-Sayed I. El-Agamy; Basem Fathi; Salma F. Abdelkader; Sameh S. Ali; Naglaa M. Aboelsoud; Nasser Ramadan; Mohamed Sobhy; Tarek Gharib

doi:10.4081/aiua.2024.12395

Authors

M. Abdelwadood Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Eman H. Ibrahim
dr.eman@gmu.ac.ae
Department of Pathology Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates.
Tamer A. Abouelgreed Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. https://orcid.org/0000-0003-2640-3425
Yasser M. Haggag Department of Urology, Faculty of Medicine, Al-Azhar University, Asyut, Egypt. https://orcid.org/0009-0009-3245-4529
Mohamed M. Yassin Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Mohamed A. Elhelaly Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. https://orcid.org/0009-0008-9524-8629
El-Sayed I. El-Agamy Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Basem Fathi Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Salma F. Abdelkader Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Sameh S. Ali Department of Radiology, Sheikh Khalifa General Hospital, UAQ, United Arab Emirates.
Naglaa M. Aboelsoud Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Nasser Ramadan Department of Urology, NMC Royal Hospital, Sharjah, United Arab Emirates.
Mohamed Sobhy Department of Surgery, Faculty of Medicine, Gulf medical University, Ajman, United Arab Emirates.
Tarek Gharib Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt. https://orcid.org/0000-0001-6760-3795

Objective: To analyze the static and dynamic urodynamic parameters of reservoirs and continent conduits in continent cutaneous urinary diversion with catheterizable stoma.

Materials and methods: 76 patients had augmented ileocystoplasty or continent urinary diversion with catheterizable urinary stoma based on Mitrofanoff principle and Yang-Monti procedure using subserous tunnel as continence mechanism. They were followed up for at least 6 months post-operatively for continence through stoma and divided into two groups (continents vs non-continent) according to stomal continence. Both groups had urodynamic assessment performed via the stoma to assess reservoir capacity, pressure and contractions, efferent limb functional length, reservoir overactivity, static and dynamic maximal closure pressures and leak point pressure.

Results: Continence rate was 87%. Continent group included 66 patients and incontinent group included 10 patients. In both groups at rest, the reservoir pressure after filling did not exceed 25 cm H2O. During peristaltic contraction, the pressure did not exceed 30 cm H2O and the duct remained continent. After Valsalva maneuver, the reservoir pressure increased up to 34 (+ 7.4) cm H2O and leakage occur in 10 patients (13%). Reservoir (wall) overactivity was recorded in 54 patients, with insignificant rise in intraluminal pressure during the contractions. In both groups, the efferent tract closing pressure was always higher than the reservoir pressure. The mean of maximal closing pressure at Valsalva was 82.5 (+ 4.18) cm H2O in the continent group and 61.66 (+ 8.16) cm H2O in the incontinent group. The mean functional length of the conduit was 4.95 + 1.62 in the continent group and 2.80 + 1.50 cm in the incontinent group.

Conclusions: Urodynamic evaluation of continent catheterizable cutaneous stoma after Yang-Monti procedure has a practical significance. Functional length of the conduit seems to be the most influential factor for continence reflecting static & dynamic maximal closure pressure. Higher conduit closing pressure is associated with better continence. Contractions of the pouch and peristaltic contraction of the conduit has no effect on continence mechanism.

Abouelgreed T, Saleh D, Abdelaal M, et al. Urodynamic changes following laparoscopic versus vaginal hysterectomy. Arch Ital Urol Androl. 2022; 94:315-318. DOI: https://doi.org/10.4081/aiua.2022.3.315

Kupec T, Pecks U, Gräf CM, et al. Size Does Not Make the Difference: 3D/4D Transperineal Sonographic Measurements of the Female Urethra in the Assessment of Urinary Incontinence Subtypes. Biomed Res Int. 2016; 2016:1810352. DOI: https://doi.org/10.1155/2016/1810352

Ramanan V, Kapoor R, Srinadh ES, et al. Mitrofanoff principle for continent urinary diversion.Urol Int. 1997; 58:108-112. DOI: https://doi.org/10.1159/000282961

Monti PR, de Carvalho JR. Transverse tubulization of intestinal segments: a catheterizable conduit as an alternative to the Mitrofanoff procedure. Prog Urol. 2001; 11:382-384.

Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol. 2008; 22:2393-2396. DOI: https://doi.org/10.1089/end.2008.0256

Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendico-vesicostomy. J Urol. 2011; 185:1438-1443. DOI: https://doi.org/10.1016/j.juro.2010.11.050

Elshal AM, Abol-Enein H, Sarhan O, et al. Catheterizable serous lined urinary outlet in children and adolescents: a choice when other treatments fail. J Urol. 2011; 185:1083-1087. DOI: https://doi.org/10.1016/j.juro.2010.10.041

Mhiri MN, Bahloul A, Chabchoub K. Mitrofanoff appendicovesicostomy in children: indication and results. Prog Urol. 2007; 17:245-249. DOI: https://doi.org/10.1016/S1166-7087(07)92272-1

Surer I, Ferrer FA, Baker LA, Gearhart JP. Continent urinary diversion and the exstrophy-epispadias complex. J Urol. 2003; 169:1102-1105. DOI: https://doi.org/10.1097/01.ju.0000044921.19074.d0

Clark T, Pope JC 4th, Adams mC, et al. Factors that influence outcomes of the Mitrofanoff and Malone antegrade continence enema reconstructive procedures in children. J Urol. 2002; 168:1537-1540. DOI: https://doi.org/10.1016/S0022-5347(05)64515-6

Chabchoub K, Ketata H, Fakhfakh H, et al. Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence. Prog Urol. 2008; 18:120-124. DOI: https://doi.org/10.1016/j.purol.2007.12.006

Cain MP, Andrew MD, Anthany JG, et al. Updated experience with the Monti catheterizable channel. Pediatric Urology 2008; 72:782-785. DOI: https://doi.org/10.1016/j.urology.2008.04.006

Gowda BO, Agrawal V, Harrison SC. The continent catheterizable abdominal conduit in adult urological practice. BJU Int; 2008; 102:1688-1692. DOI: https://doi.org/10.1111/j.1464-410X.2008.07885.x

Welk BK, Afshar K, Rapoport D, MacNeily AE. Complications of the catheterizable channel following continent urinary diversion: Their nature and timing. J Urol 2008; 180:1856-1860. DOI: https://doi.org/10.1016/j.juro.2008.03.093

Van der AF, Joniau S, De Baets K, De Ridder D. Continent catheterizable vesicostomy in an adult population: success at high costs. Neurourol Urodyn. 2009; 28:487-4891. DOI: https://doi.org/10.1002/nau.20699

Watson HS, Bauer SB, Peters CA, et al. Comparative urodynamics of appendiceal and ureteral Mitrofanoff conduits in children. J Urol 1995; 154:878-882. DOI: https://doi.org/10.1016/S0022-5347(01)67193-3

Abdelwadood, M., Ibrahim, E. H., Abouelgreed, T. A., Haggag, Y. M., Yassin , M. M., Elhelaly, M. A., El-Agamy, E.-S. I., Fathi, B., Abdelkader, S. F., Ali, S. S., Aboelsoud, N. M., Ramadan, N., Sobhy, M., & Gharib, T. (2024). The use of urodynamic to assess the mechanism of incontinence in patients with Yang-Monti based catheterizable cutaneous stomas. Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2024.12395