Implications of Inflammatory Bowel Disease for reconstructive surgery in non-malignant urinary tract dysfunction: an International Continence Society working group report
File(s)1-s2.0-S2772973722000091-main.pdf (590.31 KB)
Published version
Author(s)
Type
Journal Article
Abstract
Potential consequences of inflammatory bowel disease (IBD) need evaluation for patients considering urinary tract reconstruction for benign disease. A working group was formed by the International Continence Society, which considered urinary tract reconstruction in IBD.Methods Nominal group technique was used to derive consensus. Principal aspects of IBD assessment and surgery decision-making were agreed. A questionnaire was used to facilitate the generation of statements by a core focus group of experts, which were modified and ratified by the wider working group. This was followed by final voting by the full working group.Results General considerations included identification importance of the specialist IBD multi-disciplinary team. Peri-operative considerations recommended avoiding pre-operative fasting from midnight and using an enhanced recovery after surgery (ERAS) protocol. Selection of bowel segment, pre-operative optimisation and post-operative issues were considered for both Ulcerative colitis (UC) and Crohn’s disease. UC is not an absolute contraindication to urinary tract reconstruction using small or large bowel. Elective reconstructive surgery should wait at least three months following resolution of any acute UC flare-up to correct all abnormalities. Crohn’s disease is a high-risk disease for urinary tract reconstruction, even if in remission. In Crohn’s, reconstructive surgical options are limited by the location and extent of gastrointestinal segment(s) affected and the phenotype of disease.Conclusion The consensus opinion indicates that urinary tract reconstruction using bowel segments is feasible in carefully selected and optimised patients with IBD lacking alternative management options, provided there is access to appropriate multidisciplinary skills. UC is relatively low risk for surgical procedures, whereas Crohn’s has considerably increased risk of morbidity. The potential risks must be properly discussed with patients considering reconstructive urological procedures. Outcomes should be carefully monitored and published to identify the safety and efficacy of reconstructive surgery in IBD, including full description of the disease status.
Date Issued
2022-03
Date Acceptance
2022-04-01
Citation
Continence, 2022, 1, pp.1-7
ISSN
2772-9737
Publisher
Elsevier
Start Page
1
End Page
7
Journal / Book Title
Continence
Volume
1
Copyright Statement
© 2022 The Author(s). Published by Elsevier B.V. on behalf of International Continence Society. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.sciencedirect.com/science/article/pii/S2772973722000091
Notes
keywords: Urinary tract reconstruction, Urinary diversion, Cystectomy, Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis
Publication Status
Published
Article Number
100018
Date Publish Online
2022-04-02