Long‐Term Outcomes of Continent Cutaneous Urinary Diversion in Patients With Neurogenic Lower Urinary Tract Dysfunction: A Monocentric Experience

Abstract

PURPOSE: To evaluate long-term outcomes and quality of life after continent cutaneous urinary diversion (CCUD) in patients with neurogenic lower urinary tract dysfunction (NLUTD). MATERIALS AND METHODS: We conducted a retrospective, single-center study including all patients with NLUTD who underwent CCUD between 2004 and 2021. Outcomes assessed included functional success (continued CIC through the CCUD) and composite success (CIC through the CCUD with stomal continence and without major surgical revision), continence rates (stomal and urethral), urodynamic data, and early/late post-operative complications. Quality of life and satisfaction were also evaluated using validated questionnaires. RESULTS: Eighty-six patients (median age 48 years) were included, spinal cord injury being the most common cause (70.9%). Median follow-up was 6.4 years. Concomitant augmentation cystoplasty (AC) was performed in 24.4% of cases. At last follow-up, functional success was 87.1%, and composite success was 71.8%. Stomal and urethral continence rates were 92.4% and 100%. Severe early complications occurred in 13.9%. Stomal/tube stenosis was reported in 29%, with 21 requiring surgery. Stomal incontinence occurred in 7.6%, and 15.1% required additional urethral continence surgery. Five patients (8.2%) required secondary AC. The overall reoperation rate was 65.1%. Patient satisfaction was high (91.5%). CONCLUSION: CCUD is a reliable long-term option for patients with NLUTD, offering high continence and satisfaction rates despite a significant reoperation rate. A low rate of concomitant AC was achieved while maintaining a low-pressure reservoir, warranting confirmation in prospective comparative studies. Careful patient selection and long-term follow-up remain essential to ensure lasting surgical success.