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Implications of Inflammatory Bowel Disease for reconstructive surgery in non-malignant urinary tract dysfunction: An International Continence Society working group report

Sihra, N; Williams, A; Emmanuel, A; Lopez, NZ; Sahai, A; Hamid, R; Neshatian, L; ... Barratt, R; + view all (2022) Implications of Inflammatory Bowel Disease for reconstructive surgery in non-malignant urinary tract dysfunction: An International Continence Society working group report. Continence , 1 , Article 100018. 10.1016/j.cont.2022.100018. Green open access

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Abstract

Introduction: 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 identifying the 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.

Type: Article
Title: Implications of Inflammatory Bowel Disease for reconstructive surgery in non-malignant urinary tract dysfunction: An International Continence Society working group report
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.cont.2022.100018
Publisher version: https://doi.org/10.1016/j.cont.2022.100018
Language: English
Additional information: © 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/).
Keywords: Urinary tract reconstruction, Urinary diversion, Cystectomy, Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10180178
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