Urologic and plastic surgical collaboration for continent diversion when urine leakage is complicated by pressure ulcers or obesity

Background: Patients with neurogenic bladder dysfunction and urine leakage combined with pressure ulceration, fistulae, and/or obesity present a major surgical challenge. Given the urgent need to control urine leakage, suprapubic cystostomy or incontinent urinary diversion such as ileal conduit often are chosen for definitive intervention, despite the fact that continent urinary diversion generally is the preferred method of management for the motivated patient. Design: Case series. Method: This article presents 4 patients in whom urine leakage was complicated by pressure ulcers, urethral erosion, and/or morbid obesity. Due to the complicated nature of their problems, these patients were managed in a collaborative fashion by the departments of urology, plastic surgery, and physiatry. Each of these patients underwent a combined surgical intervention that addressed issues of skin ulceration or morbid obesity and allowed for continent urinary diversion. Results: After intervention, all 4 patients were independent in bladder management and were completely continent. Conclusion: This series demonstrates how collaboration between the urologist and plastic surgeon in evaluation and treatment planning allows for the formulation of surgical options that include continent urinary diversion.