Urinary Diversion Surgery May Be Used as Last Resort for Treating Urological Dysfunction in MS Patients, Study Shows

A surgical technique known as non-continent urinary diversion is an effective last-resort solution for treating urological dysfunction in people with multiple sclerosis (MS), a new study shows.

Titled “Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis,” the study was published in the journal Neurology and Urodynamics.

People with MS can present with a wide variety of clinical symptoms that affect various organs, including those outside of the central nervous system.

Lower urinary tract symptoms, or LUTS, tend to affect up to 80% of MS patients. These symptoms — which include any dysfunction related to urinating, such as difficulty emptying the bladder and problems storing urine — tend to change as MS evolves, and have been shown to have a negative impact on patients’ quality of life.

MS‐related urological dysfunctions also can lead to several complications, such as recurrent urinary tract infections, the formation of kidney stones, and renal (kidney) failure.

Therefore, urological management of MS patients is essential for maintaining an optimal quality of life, and preventing urological complications.

In most cases, people with MS who have urological problems are prescribed conventional therapies that are administered either orally or through an injection. However, these therapies can sometimes be insufficient to control LUTS.

In such cases, a surgical approach using non-continent urinary diversion may be an option. Urinary diversion is a surgical procedure that creates a new way for urine to pass out of the body.

Now, researchers at the Pitié‐Salpêtrière Academic Hospital, Assistance Publique‐Hôpitaux de Paris, of the Sorbonne Université in France, investigated the long‐term outcomes and complications of such surgery among people with MS. Their analysis included 91 patients who underwent non-continent urinary diversion to treat LUTS between 2000 and 2015.

In particular, the researchers focused on patients who underwent ileal conduit urinary diversion — a system for urinary drainage created using a small portion of the intestine, called the ileum, after removing the bladder. In this system, urine is drained from the kidney into an external pouch.

Early post-surgical complications, long‐term complications, reoperation rates, and renal function were analyzed for these patients. Their median age at the time of surgery was 56 years (ranging from 30 to 77), and their median follow‐up was 50 months.

The surgery was indicated for various reasons including: refractory urinary incontinence (involuntary loss of urine; 73 patients); renal failure (eight patients); ulcer of the perineal skin due to urinary incontinence (six patients); and recurrent urinary tract infections (four patients).

The results showed a significant reduction in the rate of post-operative non-obstructive pyelonephritis — inflammation of the kidney — in patients who underwent an ileal conduit urinary diversion. However, there was no significant difference between preoperative and postoperative renal function.

Complications were graded according to the Clavien‐Dino system — Clavien I and II represent minor complications, while Clavien III to V signify major ones. Early postoperative complications were reported among 24 patients (26%), and were mostly major complications — Clavien III to V. Among them, nine patients (9.9%) required reoperation for these early complications.

Late complications were reported in 28 patients (30.8%). These included 10 cases of pyelonephritis, or inflammation of the kidney, eight cases of ureteral anastomosis stenosis, or the narrowing of the tube that drains urine, and six cases of kidney or ureteral stones. Two patients had stoma stenosis, or narrowing of the opening in the abdomen that connects to the urinary system, and two had incisional hernias — incompletely healed surgical wounds.

Among the individuals with late complications, 15 (16.5%) required reoperation for treatment.

Based on the results, the team suggested that “noncontinent urinary diversion using ileal conduit appears to be an effective end‐stage solution in MS patients.”

The researchers noted, however, that “the perioperative morbidity rate of 26%, and the late complication rate of 31% should be considered to better inform patients before the surgery.”

“Preoperative assessment [from the time the patient goes into the hospital for surgery until the time the patient goes home] is crucial to prevent early complications linked to MS, and a regular follow‐up is essential to detect and treat in a timely fashion late complications,” the investigators concluded.