The effect of urinary tract reconstruction on neurologically impaired women previously treated with an indwelling urethral catheter

Toyohiko Watanabe, David A. Rivas, Robin Smith, William E. Staas, Michael B. Chancellor

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose: We investigated the changes in sexuality and quality of life that evolve after lower urinary tract reconstruction in neurologically impaired women previously treated with an indwelling urethral catheter. Materials and Methods: A total of 18 neurologically impaired women treated with an indwelling urethral catheter underwent bladder reconstruction. Pubovaginal sling urethral compression was required to restore perineal dryness in 13 patients and was the only operation required in conjunction with intermittent catheterization in 3. Eight patients underwent ileocystostomy, that is creation of a 'bladder chimney,' and 4 underwent augmentation cystoplasty with creation of a continent catheterizable stoma. In 3 patients ileocystoplasty alone with intermittent urethral catheterization was performed. All patients were followed 6 to 40 months (mean 18) after reconstructive surgery using a 9-part questionnaire to score numerically the effect of surgical reconstruction on sexuality and quality of life issues. Results: On a scale of 0 (worst) to 5 (best) mean scores for self-esteem improved from 1 preoperatively to 4 postoperatively, self-image from 1 to 4, sexual desire from 2 to 4 and ability to cope with disability from 1 to 4, respectively. In 4 of the 15 women who were sexually active preoperatively the frequency of sexual intercourse doubled from a mean of 3 to 6 times per month, respectively, and all 4 women reported improved sexual satisfaction. All 13 patients with pelvic pain and 5 with symptoms of autonomic dysreflexia noticed significant improvement if not complete resolution of the symptoms. Conclusions: Neurogenic lower urinary tract dysfunction treated with an indwelling urethral catheter is detrimental to sexuality and quality of life in neurologically impaired women. Urinary tract reconstruction restores not only quality of life but also sexuality by improving self-image, self-esteem and the ability to cope. Indwelling catheterization as a method of long-term urinary treatment should be avoided in women.

Original languageEnglish
Pages (from-to)1926-1930
Number of pages5
JournalJournal of Urology
Volume156
Issue number6
DOIs
Publication statusPublished - Dec 1996
Externally publishedYes

Fingerprint

Urinary Catheters
Indwelling Catheters
Urinary Tract
Sexuality
Quality of Life
Aptitude
Self Concept
Catheterization
Reconstructive Surgical Procedures
Urinary Bladder
Autonomic Dysreflexia
Intermittent Urethral Catheterization
Suburethral Slings
Orgasm
Pelvic Pain
Coitus

Keywords

  • bladder, neurogenic
  • spinal cord injuries
  • urethra
  • urinary incontinence
  • urodynamics

ASJC Scopus subject areas

  • Urology

Cite this

The effect of urinary tract reconstruction on neurologically impaired women previously treated with an indwelling urethral catheter. / Watanabe, Toyohiko; Rivas, David A.; Smith, Robin; Staas, William E.; Chancellor, Michael B.

In: Journal of Urology, Vol. 156, No. 6, 12.1996, p. 1926-1930.

Research output: Contribution to journalArticle

Watanabe, Toyohiko ; Rivas, David A. ; Smith, Robin ; Staas, William E. ; Chancellor, Michael B. / The effect of urinary tract reconstruction on neurologically impaired women previously treated with an indwelling urethral catheter. In: Journal of Urology. 1996 ; Vol. 156, No. 6. pp. 1926-1930.
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abstract = "Purpose: We investigated the changes in sexuality and quality of life that evolve after lower urinary tract reconstruction in neurologically impaired women previously treated with an indwelling urethral catheter. Materials and Methods: A total of 18 neurologically impaired women treated with an indwelling urethral catheter underwent bladder reconstruction. Pubovaginal sling urethral compression was required to restore perineal dryness in 13 patients and was the only operation required in conjunction with intermittent catheterization in 3. Eight patients underwent ileocystostomy, that is creation of a 'bladder chimney,' and 4 underwent augmentation cystoplasty with creation of a continent catheterizable stoma. In 3 patients ileocystoplasty alone with intermittent urethral catheterization was performed. All patients were followed 6 to 40 months (mean 18) after reconstructive surgery using a 9-part questionnaire to score numerically the effect of surgical reconstruction on sexuality and quality of life issues. Results: On a scale of 0 (worst) to 5 (best) mean scores for self-esteem improved from 1 preoperatively to 4 postoperatively, self-image from 1 to 4, sexual desire from 2 to 4 and ability to cope with disability from 1 to 4, respectively. In 4 of the 15 women who were sexually active preoperatively the frequency of sexual intercourse doubled from a mean of 3 to 6 times per month, respectively, and all 4 women reported improved sexual satisfaction. All 13 patients with pelvic pain and 5 with symptoms of autonomic dysreflexia noticed significant improvement if not complete resolution of the symptoms. Conclusions: Neurogenic lower urinary tract dysfunction treated with an indwelling urethral catheter is detrimental to sexuality and quality of life in neurologically impaired women. Urinary tract reconstruction restores not only quality of life but also sexuality by improving self-image, self-esteem and the ability to cope. Indwelling catheterization as a method of long-term urinary treatment should be avoided in women.",
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