Continence (Mar 2022)
Implications of Inflammatory Bowel Disease for reconstructive surgery in non-malignant urinary tract dysfunction: An International Continence Society working group report
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.
