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Orthotopic ileal bladder substitute after radical cystectomy: Urodynamic features
Author(s) -
Porru Daniele,
Usai Enzo
Publication year - 1994
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/1520-6777(1994)13:3<255::aid-nau1930130307>3.0.co;2-v
Subject(s) - medicine , cystectomy , urination , surgery , urology , trigone of urinary bladder , bladder cancer , urethra , clean intermittent catheterization , urinary bladder , urinary system , cancer
Urodynamic investigation was performed in 12 men. 3 to 8 months after cystoprostatectomy for bladder cancer and bladder substitution, using a detubularized ileal segment as described by Studer‐Zingg. All patients underwent a standard urodynamic evaluation and extramural ambulatory urodynamic monitoring (e.a.m.). Ten patients were continent by day and 3 were incontinent during the night to a degree that necessitated use of a condom catheter. Three patients awakened every 3 hours to void and 6 had to void 1‐2 times nightly. The residual urine was over 100 ml in 3 patients; it was low or absent in the remainder. Micturition was achieved by straining, with a maximum flow rate of 13 ml per second or greater, except in 2 patients. In 2 patients a urethral narrowing was found at the urethro‐ileal anastomosis, and in 1 of them an incoordination between the neobladder and the pelvic floor required the use of a urethral catheter and a subsequent protocol of pelvic floor rehabilitation. The incidence of nocturnal incontinence was 56.6%. In 2 patients urethral pressure profile revealed hypotonia, with a maximum urethral closure pressure (MUCP) < 45 cm H 2 O. During e.a.m. study pressure values in the neobladder usually ranged below 15 cm H 2 O and exceeded 35 cm H 2 O in only 1 patient who complained of daytime and nocturnal incontinence. Neobladder compliance was normal in all cases In order to achieve a complete rehabilitation after operation, the patient should be instructed to follow a careful training in order to prevent overdistention of the neobladder by voiding at regular intervals and to obtain continence. © 1994 Wiley‐Liss, Inc.