Long-term follow-up of transvaginal urethral closure and suprapubic cystostomy for urinary incontinence in women with multiple sclerosis.

OBJECTIVE

To assess the long-term success, in terms of continence and patient satisfaction, of transvaginal urethral closure and suprapubic cystostomy in women with multiple sclerosis and urinary incontinence.

PATIENTS AND METHODS

The group under study comprised 50 severely disabled women with multiple sclerosis who were undergoing suprapubic cystostomy and transvaginal urethral closure to manage urinary incontinence refractory to conservative measures and urethral catheterization. Follow-up was by patient interview and Catheter Change Clinic records.

RESULTS

An initial continence rate of 78% was achieved and secondary revision was attempted in 10%. Urinary diversion was performed in 4% and a return to urethral catheterization in 2%. Long-term follow-up (mean length 6.5 years) showed that 79% of patients remained completely dry and were managed by regular catheter change. Six per cent of women with continued leakage around the suprapubic site were managed by conservative local methods. The major complications of urethral closure and suprapubic cystostomy (recurrent calculi and encrustation blockage) related to the presence of the catheter.

CONCLUSIONS

The lack of major complications associated with transvaginal urethral closure and suprapubic cystostomy, and the high rates of continence and patient satisfaction suggest that this technique could be more widely used. Particularly, it could be employed at an earlier stage in multiple sclerosis and thus offer patients a better quality of life for a longer period of time. Modifications in catheter design may overcome problems of calculi and encrustation blockage.