The implications of neurogenic bowel dysfuncton for urinary tract reconstruction in neurogenic urinary tract dysfunction: An International Continence Society working group report

Abstract

Introduction: The consequences of neurogenic bowel dysfunction in patients with neurogenic lower urinary tract disease requiring urinary tract reconstruction with bowel harvest remains unclear. A working group was formed by the International Continence Society (ICS) to generate a consensus statement highlighting the key issues to be addressed and optimised peri-operatively. Methods: Nominal group technique was used to derive consensus. Principal aspects of assessment and surgery decision-making were agreed and a series of statements was generated by a core focus group of experts, which were subsequently modified and ratified by the wider working group. This was followed by final voting by the full working group. Results: General considerations included the importance of understanding the neurological condition in terms of degree of disability, prognosis and risk of progression, an assessment of cognition and dexterity and an inter-disciplinary assessment to ensure suitability and feasibility of surgery. Peri-operative recommendations included using an enhanced recovery after surgery (ERAS) protocol when appropriate and taking additional precautions if there is a risk of autonomic dysreflexia or the presence of implants such as ventriculo-peritoneal shunts, baclofen pumps, sacral or spinal cord stimulators. Extra consideration must be taken post-operatively to minimise the risk of venous thrombo-embolism formation, formation/exacerbation of pressure sores and long-term bowel disturbance. Conclusion: The consensus opinion indicates that urinary tract reconstruction using bowel segments is feasible in carefully selected and optimised patients with neurogenic bowel dysfunction, provided the potential implications for serious adverse events are carefully considered and there is access to appropriate inter-disciplinary expertise.