Ileovesicostomy as an alternative form of bladder management in tetraplegic patients

Bladder management in tetraplegic patients traditionally has been intermittent catheterization by a caretaker, placement of indwelling suprapubic or urethral catheters, sphincterotomy and external catheter drainage, or supravesical urinary diversion with an ileal conduit. The aim of this study was to examine the ileovesicostomy as an alternative form of bladder management in such patients. We report our experience with ileovesicostomy as an incontinent cutaneous urinary diversion not requiring ureteral reimplantation. Six tetraplegic patients who had experienced significant morbidity with their preoperative form of bladder management were managed with an ileovesicostomy fashioned like a funnel from the bladder dome to the right lower quadrant. All patients underwent preoperative and postoperative fluoroscopic and urodynamic evaluations. Patients were evaluated preoperatively and followed postoperatively with serum chemistries, upper urinary tract imaging, and urine bacteriologic studies. There were no perioperative complications. Postoperative urodynamics demonstrated subjects to have a mean stomal leak-point pressure of 7.7 cm H 2O (range 5 to 10). Radiographically, patients carried low urinary residuals (less than 100 cc) and did not exhibit vesicoureteral reflux. In follow-up of 12 to 15 months, no patient has demonstrated calculus formation, hydronephrosis, autonomic dysreflexia, or worsening renal function. This procedure successfully creates continuous urinary drainage without catheterization, while maintaining the native antireflux mechanism of the ureterovesical junction and avoiding indwelling foreign materials in the urinary tract. Longer follow-up with more cases will be necessary to confirm these findings and to support a recommendation of the incontinent ileovesicostomy as a standard method for managing the neurogenic bladder in tetraplegic patients.