Neobladder overactivity; an equivalent to spontaneous rectal contraction

  A 76‐year‐old man had transitional cell carcinoma of the bladder and underwent orthotopic ileal neobladder, and developed severe nocturnal enuresis. We performed videomanometry in the ileal neobladder and the rectum of the patient. Slow filling of the ileal neobladder showed overactivity (the amplitudes up to 50 cmH2O), which was similar to that normally seen in the rectum (the amplitudes up to 20 cmH2O). In contrast to the normal rectal sensation, neobladder sensation was markedly decreased. During urination, the patient voided with strain and overactivity, both of which were similar to that seen in the rectum. Urethral sphincter function was preserved in the patient. In conclusion, both decreased sensation and neobladder overactivity, an equivalent to spontaneous phasic contraction of the rectum, contributed to nocturnal enuresis in our patient. Bowel‐targeted management may be necessary to minimize nocturnal enuresis in bladder‐substituted patients.