Prospective Evaluation of Laparoscopic Assisted Cystectomy and Ileal Conduit in Advanced Multiple Sclerosis

• Published in: Urology (Ridgewood, N.J.) N.J.), 2012-10, Vol.80 (4), p.852-857
• Main Authors: Guillotreau, Julien, Panicker, Jalesh N, Castel-Lacanal, Evelyne, Viala, Frédérique, Roumiguié, Mathieu, Malavaud, Bernard, Marque, Philippe, Clanet, Michel, Rischmann, Pascal, Gamé, Xavier
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Constriction, Pathologic - etiology; Cystectomy - adverse effects; Disability Evaluation; Female; Humans; Kidney - physiology; Laparoscopy - adverse effects; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - surgery; Male; Medical sciences; Middle Aged; Multiple Sclerosis - complications; Multiple Sclerosis - physiopathology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nephrology. Urinary tract diseases; Neurologic Examination; Neurology; Pyelonephritis - etiology; Quality of Life; Surveys and Questionnaires; Ureter - pathology; Urinary Diversion - adverse effects; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.06.039

Objective To assess the morbidity, mortality, and impact on quality of life and renal function after laparoscopic cystectomy and ileal conduit in patients with multiple sclerosis with lower urinary tract symptom refractory to conservative management. Materials and Methods A prospective study was conducted between February 2004 and December 2010 on 44 consecutive patients with multiple sclerosis who underwent laparoscopic cystectomy and ileal conduit for lower urinary tract symptom. Median Expanded Disability Status Scale score was 8 (6.5-8.5). Mean duration of multiple sclerosis was 19.3 ± 7.9 years. The quality of life was determined using the validated Qualiveen questionnaire preoperatively and at minimum 6 months after the surgery. Results No conversion to open surgery was required. Postoperative morbidity rate was 18.2%; minor (Clavien ≤ 2) and major (Clavien ≥ 3) complications occurred in 13.6% and 6.8%, respectively. Mean follow-up was 44.5 ± 20.6 months. Complications noted were asymptomatic ureteroileal stenosis (n = 6) and pyelonephritis (n = 3). Neurological status and Expanded Disability Status Scale score remained stable throughout. Renal function remained unchanged. Limitations, constraints, and specific urinary impact index subscores of the Qualiveen were significantly improved at 6 months time. Conclusion Laparoscopic cystectomy and ileal conduit for lower urinary tract symptom in advanced multiple sclerosis is a safe procedure with low complications. Neurological status and renal function remain stable and quality of life improves and continues to remain improved during long-term follow-up, suggesting this to be an attractive option in patients with advanced multiple sclerosis with lower urinary tract symptom refractory to conservative treatment.