Abedi Aidin, Ojeda Luis Morales, Montero Stefania, Ha Nhi, Kohli Priya, Gaburak Petr, Abedi Armita, Chapman David, Kreydin Evgeniy, Ginsberg David A
USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Urol. 2025 May;213(5):617-627. doi: 10.1097/JU.0000000000004392. Epub 2024 Dec 17.
Patients with refractory neurogenic bladder dysfunction may require urinary reconstruction due to severe incontinence, difficulty with catheterization, and to prevent upper urinary tract compromise. We evaluated long-term decisional regret and associated factors after urinary reconstruction in patients with spinal cord injury.
We interviewed patients with spinal cord injuries who underwent bladder reconstruction surgery at least 10 years ago, administering validated surveys on bowel quality of life (QoL) and dysfunction, UTIs, and decisional regret. Daily bladder management and symptoms were assessed using the Neurogenic Bladder Symptom Score, a validated questionnaire consisting of 3 domains that examine incontinence, storage and voiding, and other health and QoL consequences of neurogenic lower urinary tract dysfunction. Demographics, injury characteristics, and surgical modality were collected through chart reviews. Decisional regret was compared among subgroups and correlated with patient-reported outcomes.
We evaluated 52 patients (41 men, 78.8%; mean age 54.9 ± 10 years) with average follow-up of 30 ± 8.6 years of postinjury and 21.9 ± 5.3 years of postsurgery. Reconstruction procedures mostly included bladder augmentation (n = 38, 73.1%) and augmentation with continent catheterizable stoma (n = 9, 17.3%). Most of the patients were of Hispanic origin (n = 41, 78.8%) with complete spinal cord injuries (n = 39, 76%). The median decision regret score was 7.5 (IQR: 0-25), indicating low regret among most participants. Bladder irrigation frequency ( = .002) was associated with decision regret, while other patient and surgical factors (eg, demographics, UTI frequency, and surgery type) were not. Surgical regret was moderately correlated with diminished bowel-related QoL ( = 0.333, = .016) and increased Neurogenic Bladder Symptom Score ( = 0.328, = .018). The Incontinence ( = 0.286, = .040) and Consequences ( = 0.299, = .031) domains of this measure showed weak statistically significant correlations with regret, while the Storage and Voiding domain did not reach significance ( = 0.245, = .080).
Long-term follow-up suggests that lower urinary tract reconstruction with bowel interposition is a well-accepted and durable approach for managing refractory neurogenic bladder. Factors associated with decision regret, such as need for irrigation, should be incorporated in patient-centered decision-making.
难治性神经源性膀胱功能障碍患者可能因严重尿失禁、导尿困难以及预防上尿路损害而需要进行尿路重建。我们评估了脊髓损伤患者尿路重建术后的长期决策后悔及相关因素。
我们对至少在10年前接受膀胱重建手术的脊髓损伤患者进行了访谈，采用经过验证的关于肠道生活质量（QoL）、功能障碍、尿路感染和决策后悔的调查问卷。使用神经源性膀胱症状评分评估日常膀胱管理和症状，这是一份经过验证的问卷，由3个领域组成，用于检查尿失禁、储尿和排尿以及神经源性下尿路功能障碍的其他健康和生活质量后果。通过病历审查收集人口统计学、损伤特征和手术方式。比较各亚组之间的决策后悔情况，并将其与患者报告的结果相关联。
我们评估了52例患者（41例男性，占78.8%；平均年龄54.9±10岁），受伤后平均随访30±8.6年，术后平均随访21.9±5.3年。重建手术主要包括膀胱扩大术（n = 38，占73.1%）和带可控造口的膀胱扩大术（n = 9，占17.3%）。大多数患者为西班牙裔（n = 41，占78.8%），伴有完全性脊髓损伤（n = 39，占76%）。决策后悔评分中位数为7.5（四分位间距：0 - 25），表明大多数参与者后悔程度较低。膀胱冲洗频率（= 0.002）与决策后悔相关，而其他患者和手术因素（如人口统计学、尿路感染频率和手术类型）则无关。手术后悔与肠道相关生活质量下降（= 0.333，= 0.016）和神经源性膀胱症状评分增加（= 0.328，= 0.018）呈中度相关。该测量的尿失禁领域（= 0.286，= 0.040）和后果领域（= 0.299，= 0.031）与后悔存在微弱的统计学显著相关性，而储尿和排尿领域未达到显著水平（= 0.245，= 0.080）。
长期随访表明，采用肠道置入的下尿路重建是治疗难治性神经源性膀胱的一种广泛接受且持久的方法。与决策后悔相关的因素，如冲洗需求等，应纳入以患者为中心的决策过程中。
